Objective: Provide explicit expert-based
consensus recommendations for the management of adults with primary and
secondary spontaneous pneumothoraces in an emergency department and
inpatient hospital setting. The use of opinion was made explicit by
employing a structured questionnaire, appropriateness scores, and
consensus scores with a Delphi technique. The guideline was designed to
be relevant to physicians who make management decisions for the care of
patients with pneumothorax.
for observation, chest tube placement, surgical interventions, and
Outcomes: Effectiveness of
pneumothorax resolution, duration of and patient tolerance of care, and
Evidence: Literature review
from 1967 to January 1999 and Delphi questionnaire submitted in three
iterations to a multidisciplinary physician panel.
Values: The guideline development group determined by
consensus the relevant outcomes to be considered in developing the
Benefits, harms, and costs: The
type and magnitude of benefits, harms, and costs expected for patients
from guideline implementation.
Management decisions vary between patients with primary or secondary
pneumothoraces, with observation of small pneumothoraces being
appropriate only for primary pneumothoraces. The level of consensus
varies regarding the specific interventions indicated, but agreement
exists for the general principles of care.
Recommendations were peer reviewed by physician experts and were
reviewed by the American College of Chest Physicians (ACCP) Health and
Science Policy Committee.
guideline recommendations will be published in printed and electronic
form with distribution of synopses for patients and health care
providers. Contents of the guideline will be incorporated into
continuing medical education programs.