Emergency Department, Southmead Hospital, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
Medical School, University of Bristol Faculty of Medicine and Dentistry, Bristol, UK.
Emerg Med J. 2022 Apr;39(4):313-316. doi: 10.1136/emermed-2020-210647. Epub 2021 Feb 11.
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 observational evidence suggests a trend towards conservative management. The aim of this survey was to understand current emergency medicine (EM) practice in placing chest drains for the management of moderate to severe traumatic pneumothoraces.
The survey was developed through expert consensus and sent electronically to senior EM doctors in 21 sites internationally. It described 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 to . All pneumothoraces were >1 cm on imaging, but mechanism, physiology and need for ventilation varied.
Of a potential 606 respondents, 222 responses were received (37% response rate). Respondents were from five different countries, with the majority qualified for more than 10 years (median; 18 years). Within each scenario, there was a large variation in responses with the exception of tension pneumothorax. For vignettes without tension pneumothorax, there was a range from 52% (non-compromised 1 cm pneumothorax in a ventilated patient) to 89% (open pneumothorax with minimal clinical compromise) in respondents reporting that they would be or to insert a chest drain.
There is considerable variation in clinical practice involving both conservative and invasive strategies in the treatment of moderate to severe traumatic pneumothoraces. This suggests clinical equipoise for interventional trials to determine the optimal management strategy for this patient group.
多发创伤患者中约有五分之一存在创伤性气胸。传统教学要求在大多数情况下插入胸腔引流管。然而，最近的观察性证据表明，倾向于保守治疗的趋势。本调查的目的是了解目前在放置胸腔引流管以治疗中重度创伤性气胸方面的急诊医学（EM）实践。
该调查通过专家共识制定，并以电子方式发送给国际 21 个地点的高级 EM 医生。它描述了六个临床/影像学病例，询问“您在 ED 中插入肋间胸腔引流管以管理气胸的可能性有多大？”有五个五分制选项可供选择，从 到 。所有气胸在影像学上均大于 1cm，但机制、生理学和通气需求各不相同。
在潜在的 606 名受访者中，有 222 人回复（37%的回复率）。受访者来自五个不同的国家，大多数人具有 10 年以上的资格（中位数为 18 年）。在每个案例中，除张力性气胸外，答复存在很大差异。对于没有张力性气胸的病例，从 52%（通气患者中无明显受损的 1cm 气胸）到 89%（有轻微临床受损的开放性气胸），有报告称他们会 或 插入胸腔引流管的受访者比例各不相同。
在治疗中重度创伤性气胸时，涉及保守和介入策略的临床实践存在相当大的差异。这表明对于干预性试验存在临床均衡，以确定该患者群体的最佳管理策略。
