Demographic characteristics of patients diagnosed with pneumothorax in emergency department, pneumothorax management and factors affecting mortality

PURPOSE: Pneumothorax (PNX) is defined as the increase of free air in the space between the parietal and visceral leaves of the lung and associated lung collapse. Although many sources of air in the pleural space can be observed, the most common cause is air leakage from the deep parenchyma into the pleural space due to rupture of the visceral pleura. Although spontaneous and traumatic pneumothorax are common, the incidence of iatrogenic pneumothorax has increased due to increase in the routine use of diagnostic interventional methods and increase in the number of patients treated in intensive care units. Pneumothorax, which has an important place in the differential diagnosis of patients who apply to the emergency department with complaints such as shortness of breath and chest pain, can lead to life-threatening consequences if not diagnosed and intervened in a timely manner. In this study, a detailed retrospective analysis of the cases diagnosed with pneumothorax who applied to the emergency service was performed and the factors affecting mortality in pneumothorax are examined; It is aimed to assist the physician in diagnosis, treatment, follow-up and prognosis prediction in daily emergency medicine practice. There are many studies on pneumothorax; however, there are not many studies examining mortality on all pneumothoraxes. MATERİALS AND METOTS: The population of the study consisted of all patients who applied to Dicle University Medical Faculty Hospital Adult Emergency Service between 01.01.2021 and 12.31.2022 and were diagnosed with pneumothorax. In this retrospective descriptive study, the files of approximately 550 patients are scanned, insufficient file data, treatment refusal and those who left the hospital without permission are excluded from the study, and 515 patients are included in the study. Demographic and other characteristics of 515 patients are noted in detail for analysis, and the effects of each on mortality are analyzed separately. RESULTS: In our study, 427 of the patients were male (82.9%) and 88 were female (17.1%). The youngest of the participating patients was 10 months old, and the oldest was 89 years old. The mean age of all patients was 31.58±19.39 years. The mean age of the surviving patients was 30.77±18.55, while the mean age of the patients who died was 42.60±26.42 years. While 177 of our 515 cases were spontaneous pneumothorax (34.36%), 338 of them were traumatic (65.64%) pneumothorax. A total of 128 PSP (24.85%), 49 SSP (9.51%), 24 gunshot wound (4.66%), 82 stab wound (15.92%), 105 in-vehicle and out-of-vehicle traffic accident (20.38%), 80 fall from a height (15.53%), 11 simple fall (2.13%), 13 blow (2.52%), 20 iatrogenic (3.88%) pneumothorax cases are detected. Comorbid diseases of our patients are beeing categorized as DM, HT, chronic lung disease, chronic liver disease, coronary disease, CRF, SVO, malignancy and other diseases. 25 DM patients, 46 HT patients, 46 chronic lung disease patients, 2 chronic liver disease patients, 28 coronary disease patients, 15 CRF patients,6 CVO patients, 21 malignancy patients and 24 other rare diseases patients were found. Traumatic pneumothorax is detected in a total of 338 patients, cranial trauma in 60 patients (17.75%), orthopedic trauma in 134 patients (39.64%), abdominal trauma in 55 patients (16.27%), diaphragmatic injury in 6 patients (1.77%), rib fracture in 117 patients (34.61%), hemothorax in 157 patients (46.44%), vascular injury in 11 patients (3.25%), pneumomediastinium in 17 patients (5.02%) detected. According to the ECG rhythm, 345 of our 515 patients had NSR (normal sinus rhythm) (70%), 136 had ST (sinus tachycardia) (26.40%), 21 had AF (atrial fibrillation) (4.07%), 13 (2.52%) had other rhythms (bradycardia, pace rhythm, LBBB). Pneumothorax was found only on the right side in 264 (51.26%) patients, on the left side only in 199 (38.64%), and on both the right and left sides in 50 (9.70%) patients. While a pneumothorax line was detected in 281 (54.56%) of them (p=1,000), no pneumothorax line was detected in 233 (45.44%) of them. While the mean rate of pneumothorax in the lung was 30.24±26.75% in all patients, the rate of pneumothorax in the lung was 29.91±26.36% in surviving patients and 34.69±31.79% in ex ones. According to the type of treatment, 204 patients underwent simple observation with O2 (39.61%), 243 patients underwent tube thoracostomy (47.18%), and 68 patients underwent surgical treatment (13.20%). According to hospital admission symptoms, 281 patients had dyspnea, 301 had chest pain, 67 had altered consciousness, and 170 had other symptoms (intubated patient, cough, shoulder pain, and pain according to the trauma site). The duration of hospitalization is min. 0, max. 180 days, and the mean duration of hospitalization is 8.16±13.62 days. While the average hospitalization period of the patients who survived was 7.96±12.79 days, the average of the patients who died was 10.86±22.24 days. CONCLUSİON: In conclusion, pneumothorax is a pathology that all physicians can encounter, that emergency physicians should not overlook and that requires urgent intervention. Treatment of pneumothorax should be decided according to etiology, degree of pneumothorax and clinic. A wide range of treatment methods such as observation with oxygen, needle aspiration, percutaneous aspiration catheter, tube thoracostomy, VATS and thoracotomy are beeing used in the treatment of pneumothorax. The aim of treatment is to achieve full reexpansion of the lung, to eliminate symptoms, to prevent complications and to prevent recurrences. Pleurodesis and pleural abrasion can be performed to prevent recurrences. Pneumothorax requiring emergency operation can often be seen in a complicated form. The aim of surgery is to prevent recurrences and to provide definitive treatment of the disease. Key words: pneumothorax, spontaneous, trauma, ECG, comorbid diseases, treatment