Disorders of the Pleura |

Is It Time to Redefine the Management Strategy in Primary Spontaneous Pneumothorax Based on Age Criteria? FREE TO VIEW

Muhammad Ganaie, MBBS; Shiva Bikmalla, MBBS; Masood Khalil, MBBS; Muhammad Afridi, MBBS; Mohammed Haris, MBBS; Imran Hussain, MD
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University Hospital of North Staffordshire, Stoke on Trent, United Kingdom

Chest. 2014;145(3_MeetingAbstracts):281A. doi:10.1378/chest.1826561
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SESSION TITLE: Pleural Disease/Pneumothorax Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: Primary spontaneous pneumothorax (PSP) occurs in patients with no clinically apparent underlying lung disease. Those aged less than 50 year with no significant smoking history are also included in this group according to the British Thoracic Society (BTS) pneumothorax management algorithm. There is paucity of data on treatment outcomes based on age criteria. We aimed to compare treatment outcomes including successful re-inflation rates in patients aged <30 and 31-50.

METHODS: We conducted a retrospective observational study of 212 consecutive pneumothorax episodes between January 2012 and December 2012. Those with secondary spontaneous pneumothorax, iatrogenic pneumothorax and history of trauma were excluded. Patient case notes and plain chest radiographs were reviewed and data was analysed. p value of <0.05 was considered significant.

RESULTS: Of the 212 episodes, 51(33%) had PSP. 27 patients were aged <30 years and 21 were 31-50 years. There was no statistically significant difference in sex, smoking status, lung collapse size and symptom duration in both groups. Patients aged <30 years had a higher success rate with needle aspiration (NA) as first intervention (52% versus 25%, p=0.15) compared to 31-50 age group. There was no significant difference in success rate when intercostal chest tube (ICT) was used as the first intervention (64% versus 71%, p>0.99). Length of stay was similar in both groups. The need for definitive surgical intervention was lower in <30 age group (33% versus 43%, p=0.55). Similarly, recurrence rate was significantly lower in <30 age group (4% versus 29%, p=0.03).

CONCLUSIONS: PSP patients aged <30 years had better success rate with NA as first intervention and the recurrence rate was significantly lower as compared to the 31-50 age group. There was no difference in success rate with ICT or LOS.

CLINICAL IMPLICATIONS: RCT evidence in this field is limited and the sample size is too small to make any firm conclusions. Further well-designed prospective studies are needed to redefine the treatment strategies based on age criteria in the management of PSP.

DISCLOSURE: The following authors have nothing to disclose: Muhammad Ganaie, Shiva Bikmalla, Masood Khalil, Muhammad Afridi, Mohammed Haris, Imran Hussain

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