title: A need to reconsider guidelines on management of primary spontaneous pneumothorax?
abstract: BACKGROUND
  The key guidelines in the management of primary spontaneous pneumothorax (PSP) include the 2010 British Thoracic Society (BTS) Pleural Disease guideline and 2001 American College of Chest Physicians (ACCP) Consensus Statement. Current recommendations are dependent on radiographic measures which differ between these two guidelines. The aim of this study is to compare size classification of PSP cases, according to BTS and ACCP guidelines, and to evaluate guideline compliance.
  
  
  RESULTS
  We conducted a retrospective evaluation of all PSP episodes presenting to St Thomas' Hospital, London, between February 2013 and December 2014. Data was recorded from review of chest X-rays and patient records. Eighty-seven episodes of PSP in 72 patients were identified (median age 25 years, IQR 22-32.25). Classification of "large" and "small" showed the greatest disparity in those managed conservatively (12/27, 44%) or with aspiration only (11/23, 48%). In this UK study, BTS guidelines were followed in 70% of episodes with adherence to ACCP guidelines in 32% of episodes.
  
  
  CONCLUSIONS
  There is a poor agreement in size classification between BTS and ACCP guidelines, resulting in conflicting recommendations for management of PSP. Robust clinical trial evidence is required to achieve international consensus on the management of PSP.
authors.affiliation: Department of Respiratory Medicine, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
authors.forename: Jiyoon
authors.initials: J
authors.lastname: Yoon
authors.affiliation: Department of Respiratory Medicine, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. deepan.sivakumar@kcl.ac.uk.
authors.forename: Parthipan
authors.identifier: http://orcid.org/0000-0003-3740-2612
authors.initials: P
authors.lastname: Sivakumar
authors.affiliation: Department of Emergency Medicine, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
authors.forename: Kevin
authors.initials: K
authors.lastname: O'Kane
authors.affiliation: Department of Respiratory Medicine, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
authors.forename: Liju
authors.initials: L
authors.lastname: Ahmed
keywords: Emergency medicine; Guidelines; Pleural disease; Pneumothorax; Respiratory