Chest
Consensus StatementManagement of Spontaneous Pneumothorax: An American College of Chest Physicians Delphi Consensus Statement
Section snippets
Materials and Methods
The guideline development process used the Delphi method tocreate and quantify group consensus (Fig 1). The Delphi method was developed by RAND Corporation (Santa Monica, CA) researchers in the 1950s.5 Characteristics of the, Delphi method are anonymity, controlled feedback, and statistical groupresponse.6 Anonymity derives from the absence offace-to-face interaction. Participants respond independently toquestionnaires, and responses are communicated to other participantswithout being
Literature Search
The literature search retrieved nine articles,121314151617181920which included eight randomized controlled trials1213141516171819(Table 7), no meta-analyses, and one practice guideline.20 Theanalysis of the retrieved articles indicated that all of the guidelinerecommendations were grade E (lowest grade of evidence).
Delphi Technique
Three questionnaire iterations were completed with 100% participation in the first iteration, 97% participation (31 of 32) inthe second iteration (a thoracic surgeon dropped out),
Comparison to Previous Guidelines
Only one previous guideline exists for the management ofpneumothorax.20 A panel of two physicians representing the, Standards of Care Committee of the British Thoracic Society (BTS)developed this guideline by disseminating a draft to 450 physicianmembers of the BTS. The two authors modified the draft on the basis ofthe 1,052 comments received from 150 responding physicians. Theguideline methodology did not use a formal literature search. Theaudience of the BTS guideline was hospital-based
Strengths and Limitations of the Guideline
The present guideline used the Delphi method, which combineslimited evidence with expert opinion and inference in a manner thatlimits group bias to the greatest degree possible.29 Theguideline adhered to evidence-based medicine principles of beingrelevant to specific circumstances and patients.30 Becausethe recommendations are largely expert opinion based, however, they donot represent sufficiently strong evidence to form the basis forhealth-care policy.31 Physicians applying
Guideline Implementation and Consensus Data
The complete guideline and the consensus tables for theentire questionnaire are available on the internet(www.chestnet.org/publications/18098/index.html). A summaryof the guideline and algorithms are available on the Internet and areavailable for distribution by the ACCP. A quick reference guide alsowill be available.
Priorities for Future Research
The extensive search of the literature underscores the paucity ofhigh-grade data from clinical trials on which recommendations for thecare of patients with pneumothoraces can be based. Major limitations ofthe literature include the following: pooling of patients with primaryand secondary pneumothoraces; nonstandardized interventions; lack ofinformation on clinical course (natural history of untreatedpneumothorax in different clinical settings); risk stratification onthe basis of factors such as
Content Chairman
Michael H. Baumann, MD, FCCP (Pulmonary), Associate Professor of Medicine, Division of Pulmonary and Critical Care Medicine, University of Mississippi Medical Center, Jackson, MS.
Content Co-Chairman
Charlie Strange, MD, FCCP (Pulmonary), Associate Professor of, Medicine, Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC.
Methodology Chairman
John E. Heffner, MD, FCCP (Pulmonary), Professor of Medicine, Associate Dean, Medical University of South Carolina, Charleston, SC.
Project Development Committee Members
Richard
Additional References Cited by the Panel in the, Questionnaire Iterations
Bense L, Lewander R, Eklund G, et al. Nonsmoking, non-α1-antitrypsin deficiency-induced emphysemain nonsmokers with healed spontaneous pneumothorax, identified bycomputed tomography of the lungs. Chest 1993; 103:433–438
Bertrand P, Regnard J, Spaggiari L, et al. Immediate andlong-term results after surgical treatment of primary spontaneouspneumothorax by VATS. Ann Thorac Surg 1996; 61:1641–1645
Campisi P, Voitk AJ. Outpatient treatment of spontaneouspneumothorax in a community hospital using a
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Additional information about the questionnaire, consensus tables, andother data are available at www.chestnet.org/publications/18098/index.html.
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A complete list of the consensus group is located in Appendix 1.