Aims/Objectives/Background Traumatic pneumothoraces are present in one-fifth of multiple trauma victims. Traditional teaching mandates the insertion of a chest drain in the majority of cases. However, recent retrospective observational evidence suggests a trend towards conservative management. The aim of this survey was to understand the current emergency medicine (EM) practice in placing chest drains for the management of moderate/severe traumatic pneumothoraces.
Methods/Design This scoping survey was developed through expert consensus. To achieve face validity, clinical sensibility testing was performed using a pilot survey (with user feedback). There were 14 pilot-phase respondents. The survey was then modified to achieve content validity. The survey was sent electronically to senior EM doctors in 15 sites internationally, and involved six clinical/imaging vignettes asking ‘how likely are you to insert an intercostal chest drain to manage the pneumothorax in ED?’. A five-point response was available from very unlikely to very likely. All pneumothroraces were >1 cm on imaging, but mechanism, physiology and need for ventilation varied.
Results/Conclusions Of a potential 409 respondents, 141 responses were received (34% response rate). Respondents had a range of clinical experience, with the majority qualified more than 10 years (median; 19 years).
For 5/6 cases chest drain insertion was likely or very likely in >50% of responses, ranging from 52% for a non-compromised 1 cm pneumothorax in a ventilated patient to 98% for a tension pneumothorax on chest x-ray. Chest drain insertion was unlikely or very unlikely (62% of responses) in one case; an 86-year-old female on rivaroxaban with moderate respiratory compromise (respiratory rate 30 min-1) and a 2 cm pneumothorax.
There is a broad range of clinical practice involving both conservative and invasive strategies in the treatment of moderate/severe traumatic pneumothoraces. There is clinical equipoise for interventional trials to determine the optimal management strategy for this patient group.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.