Management of Spontaneous Pneumothorax in a Developing Caribbean Nation: A Clinical Practice Audit

A five year clinical audit was conducted between January 1, 2000 and January 1, 2005 to evaluate the management of patients with spontaneous pneumothoraces at three tertiary referral centres across Kingston, the capital city of Jamaica. Secondary pneumothoraces (SSP) were considered present if there was underlying lung pathology, otherwise patients were considered to have primary pneumothoraces (PSP). Data retrospectively extracted from hospital records, including patient demographics, clinical details and therapeutic outcomes, were analyzed using SPSS Version 12.0. Of the 81 cases identified, 58 patients with a mean age of 41.3 +/-18.2 years (SD) had PSP. The remaining 23 patients at a mean age of 51.8 +/-17.7 years were diagnosed with SSP from COPD (11), tuberculosis (6), asthma (3), PCP (1), endometriosis (1) and sarcoidosis (1). Recurrent SSP was present in 13/81 (16.1%) cases. One patient had a clinically diagnosed tension pneumothorax while the remaining cases were diagnosed on chest radiographs. Most cases were unilateral: 52 right sided (64.2%); 28 left sided (34.6%); 1 bilateral (1.2%). Of this, 80 patients had tube thoracostomy and 1 had aspiration as the definitive therapeutic maneouvre. Prophylactic second procedures (chemical pleurodesis in 3; open gauze pleurodeses in 5) were offered to 8/81 (9.9%) patients, all with recurrent SSP. The remaining patients had ongoing surveillance. There were no recurrences recorded during the study period. Needle aspiration and prophylactic procedures were under-utilized in this setting in contravention of evidence-based guidelines. Educational programmes and early referral to thoracic surgeons may increase the compliance with the standardized guidelines.