{
    "abstract": "Management of primary spontaneous pneumothorax (PSP) has long been contentious.\nTo identify the factors influencing interventional versus conservative management and to assess current practice patterns for moderate-to-large PSP in emergency department (ED) patients.\nAnonymous online survey of emergency medicine, respiratory medicine and thoracic surgery specialists and trainees in Australia and New Zealand. Data collected included rating the decision-making importance of potential drivers of interventional versus conservative management for PSP, initial management preference for stable patients with moderate-large PSP based on three X-ray-based scenarios (one moderate-large, one almost total collapse without mediastinal shift and one large with mediastinal shift) and awareness of evidence and current guidelines for the management of PSP.\nThere were 456 responses; 85.5% were from Australia. The most commonly reported factors influencing treatment decision-making were vital signs (96.7%) and patient-reported dyspnoea (84.3%). There was variation between specialty groups in initial treatment preference for all scenarios (P <\u20090.001) and a reduction in preference for conservative treatment as the magnitude of radiological features increased (93.8% vs 61.5% vs 32.1% respectively). Guideline recommendation awareness was low except for the 2023 British Thoracic Society guideline (60.4%).\nThis study demonstrates variation of opinion regarding the initial management of stable patients with moderate to large PSP and an increasing preference for intervention as the magnitude of radiological features increases. Guideline awareness was low, highlighting the need for an evidence-based approach to PSP management in the ED that is widely understood and accepted across speciality groups and that prioritises patient symptoms over X-ray findings.",
    "authors": [
        {
            "affiliation": "Joseph Epstein Centre for Emergency Medicine Research at Western Health, Sunshine Hospital, St Albans, Victoria, Australia.\nAustralian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia.\nCritical Care - Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia.",
            "firstname": "Anne-Maree",
            "initials": "AM",
            "lastname": "Kelly"
        },
        {
            "affiliation": "Department of Respiratory Medicine, Northern Health, Melbourne, Victoria, Australia.\nDepartment of Medicine, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.",
            "firstname": "Sanjeevan",
            "initials": "S",
            "lastname": "Muruganandan"
        },
        {
            "affiliation": "Faculty of Health and Medical Sciences, University of Auckland, Auckland, New Zealand.\nAdult Emergency Department, Auckland City Hospital, Auckland, New Zealand.",
            "firstname": "Peter",
            "initials": "P",
            "lastname": "Jones"
        },
        {
            "affiliation": "Department of Emergency Medicine, Gold Coast Hospital and Health Service, Southport, Queensland, Australia.\nFaculty of Health Sciences and Medicine, Bond University, Gold Coast, Brisbane, Australia.\nSchool of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia.",
            "firstname": "Gerben",
            "initials": "G",
            "lastname": "Keijzers"
        },
        {
            "affiliation": "Emergency and Children's Services, The Prince Charles Hospital, Brisbane, Queensland, Australia.\nDepartment of Medicine, University of Queensland, Brisbane, Queensland, Australia.",
            "firstname": "Fran",
            "initials": "F",
            "lastname": "Kinnear"
        },
        {
            "affiliation": "Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia.\nThe Alfred Emergency & Trauma Centre, Melbourne, Victoria, Australia.",
            "firstname": "Peter",
            "initials": "P",
            "lastname": "Cameron"
        },
        {
            "affiliation": "Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia.\nFaculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.",
            "firstname": "Arash",
            "initials": "A",
            "lastname": "Badiei"
        },
        {
            "affiliation": "Pleural Medicine Unit, Institute for Respiratory Health, Perth, Western Australia, Australia.\nMedical School, University of Western Australia, Perth, Western Australia, Australia.\nDepartment of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.",
            "firstname": "Yc Gary",
            "initials": "YG",
            "lastname": "Lee"
        },
        {
            "affiliation": "Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Clayton, Victoria, Australia.\nDepartment of Cardiothoracic Surgery, Monash Health, Clayton, Victoria, Australia.",
            "firstname": "Julian A",
            "initials": "JA",
            "lastname": "Smith"
        },
        {
            "affiliation": "Department of Respiratory Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia.",
            "firstname": "Emma",
            "initials": "E",
            "lastname": "Ball"
        },
        {
            "affiliation": "Consumer representative, Melbourne, Victoria, Australia.",
            "firstname": "Ethan",
            "initials": "E",
            "lastname": "Bacon"
        },
        {
            "affiliation": "Department of Radiology and Radiological Sciences, Monash University, Australia.",
            "firstname": "Roland",
            "initials": "R",
            "lastname": "Bammer"
        },
        {
            "affiliation": "School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.\nDepartment of Emergency Medicine, Monash Health, Melbourne, Victoria, Australia.",
            "firstname": "Diana",
            "initials": "D",
            "lastname": "Egerton-Warburton"
        }
    ],
    "conclusions": "This study demonstrates variation of opinion regarding the initial management of stable patients with moderate to large PSP and an increasing preference for intervention as the magnitude of radiological features increases. Guideline awareness was low, highlighting the need for an evidence-based approach to PSP management in the ED that is widely understood and accepted across speciality groups and that prioritises patient symptoms over X-ray findings.",
    "copyrights": "\u00a9 2025 The Author(s). Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians.",
    "doi": "10.1111/imj.70054",
    "journal": "Internal medicine journal",
    "keywords": [
        "emergency department",
        "guidelines",
        "pleural disease",
        "pneumothorax"
    ],
    "methods": null,
    "publication_date": "2025-03-31",
    "pubmed_id": "40162593",
    "results": "There were 456 responses; 85.5% were from Australia. The most commonly reported factors influencing treatment decision-making were vital signs (96.7%) and patient-reported dyspnoea (84.3%). There was variation between specialty groups in initial treatment preference for all scenarios (P <\u20090.001) and a reduction in preference for conservative treatment as the magnitude of radiological features increased (93.8% vs 61.5% vs 32.1% respectively). Guideline recommendation awareness was low except for the 2023 British Thoracic Society guideline (60.4%).",
    "title": "Current practice and attitudes in emergency department management of primary spontaneous pneumothorax in Australia and New Zealand: a scenario-based/survey.",
    "xml": "<Element 'PubmedArticle' at 0x788505fff920>"
}