Systematic review and meta-analysis of initial management of pneumothorax in adults: Intercostal tube drainage versus other invasive methods

<div><p>Objectives</p><p>The ideal invasive management as initial approach for pneumothorax (PTX) is still under debate. The purpose of this systematic review and meta-analysis was to examine the evidence for the effectiveness of intercostal tube drainage and other various invasive methods as the initial approach to all subtypes of PTX in adults.</p><p>Methods</p><p>Three databases were searched from inception to May 29, 2016: MEDLINE, EMBASE, and the Cochrane CENTRAL. Randomised controlled trials that evaluated intercostal tube drainage as the control and various invasive methods as the intervention for the initial approach to PTX in adults were included. The primary outcome was the early success rate of each method, and the risk ratios (RRs) were used for an effect size measure. The secondary outcomes were recurrence rate, hospitalization rate, hospital stay, and complications.</p><p>Results</p><p>Seven studies met our inclusion criteria. Interventions were aspiration in six studies and catheterization connected to a one-way valve in one study. Meta-analyses were conducted for early success rate, recurrence rate, hospitalization rate, and hospital stay. Aspiration was inferior to intercostal tube drainage in terms of early success rate (RR = 0.82, confidence interval [CI] = 0.72 to 0.95, <i>I</i>^<i>2</i> = 0%). While aspiration and intercostal tube drainage showed no significant difference in the recurrence rate (RR = 0.84, CI = 0.57 to 1.23, I² = 0%), aspiration had shorter hospital stay than intercostal tube drainage (mean difference = -1.73, CI = -2.33 to -1.13, I² = 0%). Aspiration had lower hospitalization rate than intercostal tube drainage, but marked heterogeneity was present (RR = 0.38, CI = 0.19 to 0.76, I² = 85%).</p><p>Conclusion</p><p>Aspiration was inferior to intercostal tube drainage in terms of early resolution, but it had shorter hospital stay. The recurrence rate of aspiration and intercostal tube drainage did not differ significantly. The efficacy of catheterization connected to a one-way valve was inconclusive because of the small number of relevant studies.</p><p>(Registration of study protocol: PROSPERO, CRD42016037866)</p></div

Subgroup analysis of the studies that compared aspiration and intercostal tube drainage.

<p>The subgroupings were assigned according to the subtype of pneumothorax included in each study; i.e., first episode of primary spontaneous pneumothorax versus other types.</p

Meta-analysis of the hospitalization rate associated with aspiration versus intercostal tube drainage.

<p>Meta-analysis of the hospitalization rate associated with aspiration versus intercostal tube drainage.</p

Meta-analysis of the early success rate associated with the aspiration versus intercostal tube drainage.

<p>The risk ratio for early success rate was used for effect size measure. The Mantel-Haenzel method and a random-effects model were used for calculating the pooled estimate.</p

Flow diagram showing selection of studies for review.

<p>Flow diagram showing selection of studies for review.</p

Meta-analysis of the hospital stay associated with aspiration versus intercostal tube drainage.

<p>Meta-analysis of the hospital stay associated with aspiration versus intercostal tube drainage.</p

Complications in the intervention and control arms of each study.

<p>Complications in the intervention and control arms of each study.</p

Meta-analysis of the recurrence rate within 1 year associated with aspiration versus intercostal tube drainage.

<p>Meta-analysis of the recurrence rate within 1 year associated with aspiration versus intercostal tube drainage.</p

Characteristics of burn injuries among children aged under six years in South Korea: Data from the Emergency Department-Based Injury In-Depth Surveillance, 2011-2016

<div><p>Studies show that young children are vulnerable to burn injuries. We aimed to investigate the characteristics of thermal injuries in this population. We included children below 6 years of age who visited the emergency department (ED) after thermal injuries who were registered in the Korean Emergency Department-based Injury In-Depth Surveillance (2011–2016) database. Demographic characteristics, injury-related factors, and factors associated with ED treatment were gathered from the data. Then, we divided all children into two groups according to the ED discharge status: discharge versus admission (including cases transferred to other hospitals). The characteristics of the two groups were compared, and factors associated with admission were investigated. During the study period, 11,667 children with thermal injuries visited the ED. The number of boys was higher than the number of girls, and children aged 1 year accounted for the largest proportion. Most cases occurred in spring and indoors; the home was found to be the most common place. The most common type of burn was scald burns (69%), followed by contact burns (25.9%), and the most commonly burnt body area was the upper limbs (43.7%), followed by the lower limbs (16.8%). Most children (95.8%) were discharged home. The odds for hospital admission were lower for 2–3 and 4–5 year olds than for 0–1 year olds. The odds for hospital admission for contact burns were lower and those for electrical burns were higher than odds for hospital admission for scald burns. In summary, those aged 0–1 showed the largest incidence of thermal injuries and the most common burn mechanism was scald burns. Upper limbs were the most commonly affected body area, but their odds for requiring admission was lowest. Our results could be used as baseline data for prospective interventional studies investigating ways to reduce the incidence of childhood thermal injuries.</p></div

Type of thermal injuries according to sex and age group.

<p>Type of thermal injuries according to sex and age group.</p