Pigtail catheters versus large-bore chest tubes for pneumothoraces in children treated in the emergency department.
OBJECTIVE
We sought to compare the efficacy (pneumothorax resolution and hospitalization days), pain (narcotic usage), and safety (need for repositioning or replacement) associated with placement of large-bore chest tubes versus pigtail catheters in children with pneumothoraces.


METHODS
We conducted a retrospective chart review of all patients with pneumothoraces seen in the emergency department (ED) over a 6.5-year period who received treatment by a pediatric emergency physician with either a large-bore chest tube or a pigtail catheter. We excluded patients who had catheters placed by other specialists and patients who were endotracheally intubated. We collected the following data: complications, hospital days to discharge, and narcotic pain medications taken.


RESULTS
Eleven pigtail catheters and 16 large-bore chest tubes were placed. All pneumothoraces were effectively evacuated. Three of the 11 pigtail catheters required repositioning, and one was replaced. Two of the 16 large-bore chest tubes were repositioned, and one was replaced; additionally, a pigtail catheter was added to one patient with a large-bore chest tube to facilitate evacuation of the air. Average hospital stay was similar between groups (6.2 d for pigtail catheters vs 6.8 d for large-bore chest tubes, = 0.74). Children with pigtail catheters required less narcotic pain medications than those who had large-bore chest tubes, but the differences were not significant.


CONCLUSIONS
Pigtail catheters offer a safe and effective alternative to large-bore chest tubes for patients receiving treatment for pneumothoraces in the ED.
Division of Emergency Medicine, Children's Hospital, Boston, MA, USA. Karen.Dull@TCH.Harvard.edu
Karen E
KE
Dull
Gary R
GR
Fleisher
D000293:Adolescent; D000328:Adult; D002404:Catheterization / Q000295:instrumentation*; D015505:Chest Tubes; D016009:Chi-Square Distribution; D002648:Child; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D011030:Pneumothorax / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome