Spontaneous pneumothorax outcome study (SPOT phase I): a 2-year review

We aim to describe the incidence of spontaneous pneumothorax presenting to the Emergency Department, the treatment given and the outcomes of treatment.

We conducted a retrospective review of patients with spontaneous pneumothorax presenting to the Emergency Department of the Singapore General Hospital from 1 January 2000 to 31 December 2001.

Of a total of 159 patients, with a mean age of 36.1 years (standard deviation 19.3), 94.3% were men, 75 (47.2%) were treated in the Emergency Department with chest-tube insertion, 28 (17.6%) were treated with needle aspiration, and 56 (35.2%) were observed. Significantly more patients had complete re-expansion with chest-tube (65.3%) compared with needle aspiration (17.9%) (P<0.001). Patients with needle aspiration or those being observed were more likely to have a second procedure (P<0.001), whereas patients with chest tubes were more likely to have definitive treatment subsequently (pleurodesis, thoracotomy). The mean duration of hospitalization was significantly longer for chest-tube insertion (7.4 days) compared with other groups (needle aspiration 4 days). There was no significant difference in the complication rates between treatment groups at one year.

We found a male predominance locally. Treatment with chest-tube insertion is still the most popular method in the Emergency Department. Needle aspiration results in a shorter hospitalization, but a high proportion require a second procedure. Complication rates do not seem to differ from chest-tube insertion.