title: Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement.
abstract: 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.
  
  
  METHODS
  Decisions for observation, chest tube placement, surgical interventions, and radiographic imaging.
  
  
  RESULTS
  Effectiveness of pneumothorax resolution, duration of and patient tolerance of care, and pneumothorax recurrence.
  
  
  METHODS
  Literature review from 1967 to January 1999 and Delphi questionnaire submitted in three iterations to a multidisciplinary physician panel.
  
  
  METHODS
  The guideline development group determined by consensus the relevant outcomes to be considered in developing the Delphi questionnaire.
  
  
  RESULTS
  The type and magnitude of benefits, harms, and costs expected for patients from guideline implementation.
  
  
  CONCLUSIONS
  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.
  
  
  RESULTS
  Recommendations were peer reviewed by physician experts and were reviewed by the American College of Chest Physicians (ACCP) Health and Science Policy Committee.
  
  
  METHODS
  The 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.
  
  
  BACKGROUND
  The ACCP.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Mississippi Medical Center, Jackson, MS 39216-4505, USA. mbaumann@medicine.umsmed.edu
authors.forename: M H
authors.initials: MH
authors.lastname: Baumann
authors.forename: C
authors.initials: C
authors.lastname: Strange
authors.forename: J E
authors.initials: JE
authors.lastname: Heffner
authors.forename: R
authors.initials: R
authors.lastname: Light
authors.forename: T J
authors.initials: TJ
authors.lastname: Kirby
authors.forename: J
authors.initials: J
authors.lastname: Klein
authors.forename: J D
authors.initials: JD
authors.lastname: Luketich
authors.forename: E A
authors.initials: EA
authors.lastname: Panacek
authors.forename: S A
authors.initials: SA
authors.lastname: Sahn
mesh_terms: D000328:Adult; D015505:Chest Tubes; D006801:Humans; D011030:Pneumothorax / Q000628:therapy*; D012129:Respiratory Function Tests; D055502:Secondary Prevention; D013906:Thoracoscopy