P6 Current management of primary spontaneous pneumothorax in a teaching hospitals and suitability for an ambulatory pathway

• Published in: Thorax Vol. 78; no. Suppl 4; pp. A109 - A110
• Main Authors: Mohammad, O, Peat, D, Gudur, S, Hassan, M
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Thoracic Society 06.11.2023; BMJ Publishing Group LTD
• Subjects: Hemodynamics; Pneumothorax; ‘Blowing in the wind’ – Management of pneumothorax
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thorax-2023-BTSabstracts.158

BackgroundPrimary spontaneous pneumothorax (PSP) occurs predominantly in young adults. The 2010 BTS guidelines recommended management for stable patient is needle aspiration followed by chest drain insertion in case of failure. The upcoming BTS guidelines recommend ambulatory management. We aimed to determine the current practices in managing patients with PSP and estimate the proportion of the patients who would have been suitable for ambulatory management.MethodWe retrieved from hospital records all hospitalizations with discharge code of ‘pneumothorax’ between 2020–2022. We excluded cases with age outside 18 years to 54 years age bracket, and those with history of or imaging-proved underlying lung disease. We also excluded cases with traumatic or iatrogenic pneumothorax. For those who underwent drainage for PSP, we determined that the absence of all the following would mean suitability of ambulatory drainage: tension pneumothorax, bilateral disease, haemodynamic compromise at presentation or pregnancy.ResultsThe search retrieved 160 hospital episodes. 53 admissions (for 43 patients) met the inclusion criteria. Of these 43 patients, 33 (76.74%) were males, the median age was 28 (23–36) years and 27 (62.79%) were smokers. 44 of 53 (83.01%) PSP episodes required drainage with chest drain, the first intervention in 43 episodes and needle aspiration in 1 episode. The median length of hospital stay for all patients with PSP was 2.8 days (1–5 days) and 3.3 days (2–6 days) for patients who required drainage. Out of the total 44 episodes requiring drainage, 36 (81.81%) met the suitability criteria for ambulatory management. Reasons for ineligibility for ambulation were haemodynamic instability (n=4), pregnancy (n=2), and bilateral pneumothorax (n=2).ConclusionThe recommendation of 2010 BTS guidelines for needle aspiration in PSP was not routinely followed. A substantial proportion of patients with PSP requiring drainage can be managed on ambulatory/outpatient basis. These results will be the basis for starting an ambulatory pathway locally.