Management of patients admitted with pneumothorax: a multi-centre study of the practice and outcomes in Hong Kong.
OBJECTIVE
To examine the management practice of pneumothorax in hospitalised patients in Hong Kong, especially the choice of drainage options and their success rates, as well as the factors associated with procedural failures.


METHODS
Retrospective study.


METHODS
Multi-centre study involving 12 public hospitals in Hong Kong.


METHODS
All adult patients admitted as an emergency in the year 2004 with a discharge diagnosis of 'pneumothorax' were included. Data on the management and outcomes of the various types of pneumothoraces were collected from their case records.


RESULTS
Altogether these patients had 1091 episodes (476 primary spontaneous pneumothoraces, 483 secondary spontaneous pneumothoraces, 87 iatrogenic pneumothoraces, and 45 traumatic pneumothoraces). Conservative treatment was offered in 182 (17%) episodes, which were more common among patients with small primary spontaneous pneumothoraces (71%). Simple aspiration was performed to treat 122 (11%) of such episodes, and had a success rate of 15%. Aspiration failure was associated with having a pneumothorax of size 2 cm or larger (odds ratio=3.7; 95% confidence interval, 1.2-11.5; P=0.03) and a smoking history (4.1; 1.2-14.3; P=0.03). Intercostal tube drainage was employed in 890 (82%) episodes, with a success rate of 77%. Failure of intercostal tube drainage was associated with application of suction (odds ratio=4.1; 95% confidence interval, 2.8-5.9; P<0.001) and presence of any tube complications (1.55; 1.0-2.3; P=0.03). Small-bore catheters (<14 French) were used in 12 (1%) of the episodes only. Tube complications were encountered in 214 (24%) episodes.


CONCLUSIONS
Notwithstanding recommendations from international guidelines, simple aspiration and intercostal tube drainage with small-bore catheters were not commonly employed in the management of hospitalised patients with the various types of pneumothoraces in Hong Kong.
Chan
Johnny W M
JW
Department of Medicine, Queen Elizabeth Hospital, Hong Kong.
Ko
Fanny W S
FW
Ng
C K
CK
Yeung
Alwin W T
AW
Yee
Wilson K S
WK
So
Loletta K Y
LK
Lam
B
B
Wong
Maureen M L
MM
Choo
K L
KL
Ho
Alice S S
AS
Tse
P Y
PY
Fung
S L
SL
Lo
C K
CK
Yu
W C
WC
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006723:Hong Kong; D006801:Humans; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000601:surgery*; D012189:Retrospective Studies; D013396:Suction; D016896:Treatment Outcome; D055815:Young Adult