International guidelines for the management of primary spontaneous pneumothorax (PSP) vary, and there is growing opinion that more patients could be successfully managed with observation alone. There is little published evidence detailing the outcomes of emergency department (ED) patients who have been treated for PSP. The aim of this study was to describe the clinical outcomes for patients with PSP.
This was a retrospective cohort study that was conducted by explicit medical record review that investigated adult patients with PSP who had been treated at two urban teaching hospital EDs from 1996 to 2005. The data collected included demographics, clinical data at presentation, and outcome data. The outcome of interest was the proportion of patients who were successfully treated with the initial management strategy (ie, conservative, aspiration, and tube thoracostomy). Data analysis was performed using descriptive statistics.
A total of 203 episodes of PSP in 154 patients (70% male; median age, 24 years) was identified. PSP size ranged from 5 to 100%. Ninety-one PSP patients (45%) were treated with outpatient observation, 48 patients (24%) were treated with aspiration, and 64 patients (31%) were treated with tube thoracostomy. In total, the conditions of 79% of patients (82 of 91 patients) who were treated with observation resolved without additional intervention. Aspiration was successful in 50% of cases (24 of 48 cases) where it was attempted; the conditions of 73% of PSP patients who were treated with tube thoracostomy (47 of 64) resolved without additional intervention.
These data suggest that observation alone is an effective initial treatment strategy for selected patients with PSP. They support the inclusion of an observation arm in planned prospective studies comparing different management approaches.