Chest
Special ReportThe Clinician's Perspective on Pneumothorax Management
Section snippets
Materials and Methods
A pneumothorax questionnaire was mailed to 3,000 random US ACCP members in August 1995. The mailing contained a computerized survey response form, the survey questionnaire (Table 1, Table 2, Table 3, Table 4, Table 5, Table 6, Table 7), a self-addressed return envelope, and a cover letter requesting the recipients' participation and explaining the purpose of the survey. Responses were accepted until the end of December 1995.
Results
Of the 3,000 surveys sent, 409 were completed and returned (13.6%). The mean (±SEM) number of respondents to answer each survey question was 369.4±5.9. Practicing pulmonologists comprised 43% (n=176) of the respondents; academic pulmonologists, 16.4% (n=67); thoracic surgeons, 25% (n=102); and all others, 7.3% (n=30); 8.3% (n=34) of respondents omitted the initial occupation question.
Respondents had a broad geographic representation as determined by number coding placed on the response forms.
Discussion
Practice variation is common in the treatment of spontaneous pneumothoraces and bronchopleural fistulas. Recent reviews of the management of spontaneous pneumothorax1, 2, 3 and bronchopleural fistulas4 offer therapeutic advice that by necessity must be empirical in the absence of randomized trials. Practice variation and physician empiricism in the management of spontaneous pneumothoraces may be the result of one of three broad problems.
First is the absence of sufficient research to formulate
Acknowledgments
The authors wish to thank the members of the ACCP participating in the pneumothorax survey and Kathy Jewett, of the ACCP national office, for her assistance.
References (10)
- et al.
Medical management and therapy of bronchopleural fistulas in the mechanically ventilated patient
Chest
(1990) - et al.
Spontaneous pneumothorax in patients 40 years of age and older
Ann Thorac Surg
(1966) - et al.
Civilian spontaneous pneumothorax: treatment options and long term results
Chest
(1989) Management of spontaneous pneumothorax
Am Rev Respir Dis
(1993)Pneumothorax
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Supported by the University of Mississippi Medical Center Department of Medicine Developmental Fund.