Which pneumothorax volume/size measurement method can best predict surgical indication in primary spontaneous pneumothorax patients? A comparison of six different methods

Comparison of Clinical Characteristics and Prognosis Among Spontaneous Pneumothorax Patients of Different Ages: A Two-Year Follow-Up Study

Purpose

Spontaneous pneumothorax (SP), which is usually characterized by sudden chest pain and shortness of breath, can occur at any age. In this study, patients with SP across various age groups were enrolled, and their clinical features and prognoses were compared.

Patients and Methods

The patients were divided into three groups: neonates (n=52), adolescents/adults (n=76), and elderly (n=70). All patients were followed up for two years. The patients' clinical characteristics, treatments, laboratory indicators on admission, and symptoms over two years were collected and compared. Additionally, as most patients in the elderly group had chronic obstructive pulmonary disease (COPD), data about patients' lung function tests and medication were also analyzed.

Results

Compared with adolescents/adults (6.45±0.24 days), patients with SP in the neonate and elderly groups had more comorbidities, resulting in a longer hospital stay (13.85±0.34 days in neonates and 9.50±0.36 days in the elderly). The main comorbidities in the latter two groups were neonatal asphyxia (17/52) and COPD (48/70), respectively. During the two-year follow-up period, elderly patients with SP had more long-term respiratory symptoms, including coughing, expectoration, and dyspnea, than those in the other two groups. Analysis of the main subgroup (48 COPD cases) in the elderly group revealed that, in the two years after the occurrence of pneumothorax, acute exacerbation times increased; group E cases/(A+B) cases were 4/44, 4/44, 5/43, and 7/41 every 6 months respectively. Additionally, lung function indexes (FEV1, FVC, MEF25,50,75) decreased.

Conclusion

Compared to adolescents and adults, newborn and elderly patients with SP are more prone to comorbid lung diseases and longer hospitalization times. The prognosis of neonates is significantly better than the other groups. Increased frequency of acute exacerbations and a deteriorating trend in pulmonary function were observed in patients with COPD after discharge.

Management of Blunt Chest Trauma

Common mechanisms of blunt thoracic injury include motor vehicle collisions and falls. Chest wall injuries include rib fractures and sternal fractures; treatment involves supportive care, multimodal analgesia, and pulmonary toilet. Pneumothorax, hemothorax, and pulmonary contusions are also common and may be managed expectantly or with tube thoracostomy as indicated. Surgical treatment may be considered in select cases. Less common injury patterns include blunt trauma to the tracheobronchial tree, esophagus, diaphragm, heart, or aorta. Operative intervention is more often required to address these injuries.

Methods of measurement for pneumothorax in pediatric patients: a systematic review

Accurate measurement of pneumothorax (PTX) size is necessary to guide clinical decision making; however, there is no consensus as to which method should be used in pediatric patients. This systematic review seeks to identify and evaluate the methods used to measure PTX size with CXR in pediatric patients. A systematic review of the literature through 2021 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was conducted using the following databases: Ovid/MEDLINE, Scopus, Cochrane Database of Controlled Trials, Cochrane Database of Systematic Reviews, and Google Scholar. Original research articles that included pediatric patients (< 18 years old) and outlined the PTX measurement method were included. 45 studies were identified and grouped by method (Kircher and Swartzel, Rhea, Light, Collins, Other) and societal guideline used. The most used method was Collins (n = 16; 35.6%). Only four (8.9%) studies compared validated methods. All found the Collins method to be accurate. Seven (15.6%) studies used a standard classification guideline and 3 (6.7%) compared guidelines and found significant disagreement between them. Pediatric-specific measurement guidelines for PTX are needed to establish consistency and uniformity in both research and clinical practice. Until there is a better method, the Collins method is preferred.

Watch Out for the Early Killers: Imaging Diagnosis of Thoracic Trauma

Radiologists and trauma surgeons should monitor for early killers among patients with thoracic trauma, such as tension pneumothorax, tracheobronchial injuries, flail chest, aortic injury, mediastinal hematomas, and severe pulmonary parenchymal injury. With the advent of cutting-edge technology, rapid volumetric computed tomography of the chest has become the most definitive diagnostic tool for establishing or excluding thoracic trauma. With the notion of "time is life" at emergency settings, radiologists must find ways to shorten the turnaround time of reports. One way to interpret chest findings is to use a systemic approach, as advocated in this study. Our interpretation of chest findings for thoracic trauma follows the acronym "ABC-Please" in which "A" stands for abnormal air, "B" stands for abnormal bones, "C" stands for abnormal cardiovascular system, and "P" in "Please" stands for abnormal pulmonary parenchyma and vessels. In the future, utilizing an artificial intelligence software can be an alternative, which can highlight significant findings as "warm zones" on the heatmap and can re-prioritize important examinations at the top of the reading list for radiologists to expedite the final reports.

Could the probability of surgical indication be determined after first episode of primary spontaneous pneumothorax?

OBJECTIVES

To develop a risk score model for primary spontaneous pneumothorax surgery (prolonged air leak or ipsilateral recurrence). The model was internally validated for risk estimation.

METHODS

We analyzed 453 patients with primary spontaneous pneumothorax between 2014 and 2018. Patients were randomly assigned a 2:1 ratio to the development dataset (n = 302, study cohort) or the internal validation dataset (n = 151, validation cohort). The final outcomes of patients with primary spontaneous pneumothorax, the presence or absence of surgical indications, were tracked. Multivariable logistic regression models were prepared to estimate the probability of surgical indication and a scoring model was created. It was internally validated using the validation cohort. Calibration was ascertained using the Hosmer-Lemeshow method and Brier score.

RESULTS

The surgery indication rate was 47.8% (n = 217) (prolonged air leak, n = 130; ipsilateral recurrence, n = 87). There were no demographic or radiological differences between the validation and the study cohorts. Logistic regression analysis showed that the presence of bullae or blebs (p < 0.001, odds ratio = 3.340, 95%CI = 1.753-6.363) and pneumothorax volume (p < 0.001, odds ratio = 1.033, 95%CI = 1.019-1.048) were independent risk factors for surgical indication. The scoring model significantly predicted surgical indications (area under the curve, AUC = 0.768, 95%CI = 0.714-0.821, p < 0.001). Our model showed acceptable discrimination with an AUC > 0.75 in the validation set (AUC = 0.777, 95%CI = 0.702-0.852, p < 0.001) and had an adequate calibration (Hosmer-Lemeshow test p = 0.249, Brier score = 0.25).

CONCLUSION

The internally validated primary spontaneous pneumothorax scoring model was a good predictor of the need for surgery in patients with primary spontaneous pneumothorax. Prospective external validation studies with larger patient cohorts are required.