Volume 29, Issue 160, June 2025

Effectiveness of observation vs interventional methods in treating adult patients with pneumothorax in emergency department: Systematic review

Mazi Mohammed Alanazi^1♦, Abdullah Khalid Alqasim², Abdulelah Hasan Alkhudairi²

¹Saudi and Jordanian Board Emergency Medicine, Head of Emergency Research Unit, Emergency Department, First Health Cluster, Riyadh, Saudi Arabia
²Saudi Board Emergency Medicine Resident, Emergency Department, First Health Cluster, King Saud Medical City, Riyadh, Saudi Arabia

^♦Corresponding author
Mazi Mohammed Alanazi; Saudi and Jordanian Board Emergency Medicine, Head of Emergency Research Unit, Emergency Department, First Health Cluster, Riyadh, Saudi Arabia

ABSTRACT

Background: Pneumothorax (PTX) is a life-threatening illness caused by the air accumulation in the pleural space. It presents as primary, secondary, or traumatic, and its treatment differ depending on size, symptoms, and patient stability. Observation management better than interventional methods such as chest tube insertion, recent evidence supports conservative observation in select cases. This review aimed to study the effectiveness of observation and interventional methods in adult patients with PTX. Methods: This study was conducted according to PRISMA guidelines. Searched databases included PubMed, MEDLINE, and Google Scholar for studies published between 2013 and 2024. Inclusion criteria covered original research on adult patients with primary, secondary, or traumatic PTX, comparing observation with interventional methods. Four original studies were included, with a range of clinical settings and PTX types. Result: In primary spontaneous PTX, conservative management showed a 94.4% lung re-expansion rate with fewer adverse events and shorter hospital stays compared to chest tube insertion. In trauma-related PTX, observational approaches were effective in 90% of cases, including those on positive pressure ventilation, with no increase in mortality or ICU stay duration. Recurrence was higher in conservatively managed cases of recurrent PTX, but observation remained viable for secondary cases with long recurrence-free intervals and high surgical risk. Conclusion: Observation is a safe and effective alternative to interventional treatment in selected patients with PTX. Conservative management decrease complications and hospital burden and maintain better outcomes in stable individuals.

Keywords: PTX, Conservative treatment, Interventional management, Emergency department

Medical Science, 2025, 29, e84ms3591

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DOI: https://doi.org/10.54905/disssi.v29i160.e84ms3591

Published: 16 June 2025