Which clinical factors are predictive of outcome in primary spontaneous pneumothorax management?

IF 3.4 3区医学 Q1 RESPIRATORY SYSTEM

BMJ Open Respiratory Research Pub Date : 2025-06-19 DOI:10.1136/bmjresp-2024-003089

Mohammed Zain Raza, Beenish Iqbal, Anand Sundaralingam, Dinesh Addala, Alguili Elsheikh, Rob Hallifax

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引用次数: 0

Abstract

Background: Primary spontaneous pneumothorax (PSP) occurs when air leaks into the pleural space in patients without known underlying lung disease, causing pain and breathlessness. Optimal management of PSP is not defined and we are unable to predict who will fail medical treatment (ongoing pneumothorax with prolonged air leak). We hypothesised that patients with longer symptom duration and higher symptom scores would be more likely to fail treatment.

Methods: Prospectively collected data from the Randomised Ambulatory Management of Primary Pneumothorax randomised controlled trial of ambulatory management were used to determine which clinical factors are associated with treatment failure including symptom scores, time from symptom onset to presentation, treatment allocation, vital signs, history of prior pneumothorax and size of initial pneumothorax.

Results: Overall, 63/236 patients (26.7%) failed treatment. On average, symptoms started 1 day before admission. Multivariable analysis found that patients who presented at least 1 day after symptoms began had a lower risk of treatment failure than those presenting on the day symptoms began (ORs 0.39 (0.18 to 0.81)).

Conclusion: Further work is required to determine psychological drivers of PSP presentation and risks of prolonged air leak.

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哪些临床因素可预测原发性自发性气胸治疗的结果？

背景：原发性自发性气胸（PSP）发生在无已知肺部基础疾病的患者中，当空气泄漏到胸膜间隙时，引起疼痛和呼吸困难。PSP的最佳治疗方法尚未确定，我们无法预测哪些患者治疗失败（持续气胸伴长时间漏气）。我们假设症状持续时间较长和症状评分较高的患者更有可能治疗失败。方法：前瞻性收集原发性气胸随机门诊管理随机对照试验的数据，以确定哪些临床因素与治疗失败相关，包括症状评分、从症状出现到出现的时间、治疗分配、生命体征、既往气胸史和初始气胸大小。结果：总体而言，63/236例患者（26.7%）治疗失败。平均在入院前1天出现症状。多变量分析发现，在症状开始后至少1天出现的患者治疗失败的风险低于在症状开始当天出现的患者（or为0.39(0.18至0.81)）。结论：需要进一步的工作来确定PSP表现的心理驱动因素和长时间空气泄漏的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMJ Open Respiratory Research RESPIRATORY SYSTEM-

CiteScore

6.60

自引率

2.40%

发文量

审稿时长

12 weeks

期刊介绍： BMJ Open Respiratory Research is a peer-reviewed, open access journal publishing respiratory and critical care medicine. It is the sister journal to Thorax and co-owned by the British Thoracic Society and BMJ. The journal focuses on robustness of methodology and scientific rigour with less emphasis on novelty or perceived impact. BMJ Open Respiratory Research operates a rapid review process, with continuous publication online, ensuring timely, up-to-date research is available worldwide. The journal publishes review articles and all research study types: Basic science including laboratory based experiments and animal models, Pilot studies or proof of concept, Observational studies, Study protocols, Registries, Clinical trials from phase I to multicentre randomised clinical trials, Systematic reviews and meta-analyses.