Presenting hydrothorax predicts failure of needle aspiration in primary spontaneous pneumothorax

Publication date: Available online 11 March 2016
Source:The American Journal of Emergency Medicine
Author(s): Kwok Kei Wu, Chun Tat Lui, Chik Leung Ho, Kwok Leung Tsui, Hin Tat Fung
ObjectiveTo evaluate if existence of hydrothorax in initial chest X-ray predict treatment outcome in patients with primary spontaneous pneumothorax received needle thoracostomy.MethodsThis is a retrospective cohort study carried out from January 2011 to August 2014 in one public hospital in Hong Kong. All consecutive adult patients aged 18 years or above who attended the emergency department with the diagnosis of primary spontaneous pneumothorax with needle aspiration was performed as primary treatment were included. Age, smoking status, size of pneumothorax, previous history of pneumothorax, aspirated gas volume and presence of hydropneumothorax in initial X-ray were included in the analysis. The outcome was successful or failure of the needle aspiration. Logistic regression was used to identify the predicting factors of failure of needle aspiration.ResultThere were totally 127 patients included. 73 patients (57.5%) were successfully treated with no recurrence upon discharge. Among 54 failure cases, 13 patients (10.2%) failed immediately after procedure as evident by chest X-ray that require second treatment. 41 patients (32.3%) failed upon subsequent chest X-rays. Multivariate logistic regression showed factors independently associated with the failure of needle aspiration, which included hydropneumothorax in the initial X-ray (OR=4.47 [1.56 – 12.83], p=0.005), previous history of pneumothorax (OR=3.92 [1.57-9.79], p=0.003) and large size of pneumothorax defined as apex-to-cupola disease ≥ 5cm (OR=2.75 [1.21-6.26], p=0.016).ConclusionsHydropneumothorax, previous history of pneumothorax and large size were independent predictors of failure of needle aspiration in treatment of primary spontaneous pneumothorax.

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