Questionnaire Survey on Management of Spontaneous Pneumothorax

P Lee, CBE Chee, YT Wang
Correspondence: Dr Lee Pyng, lee_pyng@notes.ttsh.gov.sg

ABSTRACT
Introduction Management of spontaneous pneumothorax (SP) is variable and the initial management of SP is often undertaken by frontline junior medical staff.
Objectives To assess if medical education in the principles of SP management is adequate and to determine if practice variability exists among different disciplines.
Methods A validated questionnaire survey on the knowledge and practice of the junior medical staff posted to a general hospital from May to December 1998 was performed. 138 doctors posted to the various departments: medical (n = S9), surgical (n = 46) and emergency (n = 33) were surveyed.
Results The response rate was 95%. 73% surveyed had experience inserting chest tubes (CT). Of the 27% (n = 37) who had never inserted CT, 41% were medical officers. Our results showed adequate knowledge pertaining to initial management of primary SP (PSP). The preferred site and method for CT insertion was the 5th intercostal space, anterior axillary line and open method. There was significant practice variability in the CT size, method of insertion and CT removal sequence among the disciplines (p < 0.05). However a significant proportion of staff (49%) chose to observe or aspirate an acutely breathless patient with a 10% secondary SP (SSP) instead of CT insertion.
Conclusion While knowledge in PSP appears adequate, management of SSP and practical training in CT insertion must be emphasized as it is a simple procedure that is potentially life-saving.

Keywords: pneumothorax, spontaneous, education, practice variability
Singapore Med J 2000; 41(11): 538-541