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TENSION PNEUMOTHORAX MANAGEMENT, RECENT UPDATES, A CASE CONTROL STUDY

Noor Omar Bamohammed1 , Ayat Yousuf Alyousuf2 , Shatha Mohammed AlThobaiti 3 , Sadiq Abdullah Alali4 , Abdulaziz Ahmed Almutayliq5 , Abdulmalik Sadiq Surrati 6 , Ali Saeed Baselem7 , Faisal Abdulaziz Almajayishi8 , Mohanned Mohammed Alrahili9 , Nawaf Turki Alkhurayb10 , Wala Mehmud Patwa11

Background:Tension Pneumothorax is considered as the most common and life-threatening clinical condition, which may require emergency treatment in Emergency Medicine Departments. Objectives:We wanted to measure and estimate number of patients admitted to the Emergency Department with pneumothorax. Material and Methods:This case-control study was conducted at king abdulaziz National Guard hospital, KSA of patients treated with the diagnosis of pneumothorax between August 2017 to June 2018. Patient data were collected from hospital analysis system. According to the etiology of the pneumothorax, study groups were arranged like tension pneumothorax and traumatic pneumothorax. Results:79% (n = 106) of patients were male and 17.8% (n = 23) of patients were female and mean age were 31.3 ± 20,2 (Minimum: 1, Maximum: 87). 68.2% (n = 88) of patients were tension pneumothorax (61.36%, n=79 were primary spontaneous pneumothorax) and 31.8% (n = 41) of patients were traumatic pneumothorax (21.95% were iatrogenic pneumothorax). Main complaint is shortness of breath (52.3%, n=67) and 38% (n=49) of patients were smokers. Posteroanterior (PA) Chest X-Ray has been enough for 64.3% (n = 83) of the patients' diagnosis. Tube thoracostomy is applied to 84.5% (n = 109) of patients and surgery is applied to 9.3% (n = 12) of patients and 6.2% (n = 8) of patients were discharged with conservative treatment. tension pneumothorax showed statistically significant high recurrence compared with traumatic pneumothorax (P = 0.007). 4.65% of (n = 6) patients died. The average age of those who died (9.3 ± 19.9), statistically were significantly lower the mean age of living patients (32.4 ± 19.7) (t test, P = 0,006). 83.33% of the patients who died were neonatals and in the 0-1 years age group, and five of these patients were secondary spontaneous pneumothorax, and one of these patients were iatrogenic pneumothorax due to mechanical ventilation. Conclusions:The existing evidence indicates that needle aspiration is at least as safe and effective as tube thoracostomy for management of pneumothorax. Pneumothorax in adults can be treated by tube thoracostomy or surgically. Despite treatment, mortality of secondary and tension pneumothorax in newborns and 0-1 years age group is high. Keywords: Tension, Emergency Medicine, Pneumothorax

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