Current practice and attitudes in emergency department management of primary spontaneous pneumothorax in Australia and New Zealand: a scenario‐based/survey

• DOI: 10.1111/imj.70054
• Publication Date: 2025-04-01T11:46:33Z
• Authors: Anne‐Maree Kelly; Sanjeevan Murugan...; Peter Jones; Gerben Keijzers; Fran Kinnear; Peter Cameron; Arash Badiei; YC Gary Lee; Julian A Smith; Emma Ball; Ethan Bacon; Roland Bammer; Diana Egerton‐War...
• Keywords: Guideline; Conservative Management; Specialty; Cardiothoracic surgery

ABSTRACT Background Management of primary spontaneous pneumothorax (PSP) has long been contentious. Aims To identify the factors influencing interventional versus conservative management and to assess current practice patterns for moderate‐to‐large PSP in emergency department (ED) patients. Methods Anonymous online survey medicine, respiratory medicine thoracic surgery specialists trainees Australia New Zealand. Data collected included rating decision‐making importance potential drivers PSP, initial preference stable patients with moderate‐large based on three X‐ray‐based scenarios (one moderate‐large, one almost total collapse without mediastinal shift large shift) awareness evidence guidelines PSP. Results There were 456 responses; 85.5% from Australia. The most commonly reported treatment vital signs (96.7%) patient‐reported dyspnoea (84.3%). was variation between specialty groups all ( P < 0.001) a reduction as magnitude radiological features increased (93.8% vs 61.5% 32.1% respectively). Guideline recommendation low except 2023 British Thoracic Society guideline (60.4%). Conclusion This study demonstrates opinion regarding moderate an increasing intervention increases. low, highlighting need evidence‐based approach ED that is widely understood accepted across speciality prioritises patient symptoms over X‐ray findings.