{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T16:42:12Z","timestamp":1792428132813,"version":"4.5.0"},"reference-count":23,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T00:00:00Z","timestamp":1743379200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Management of primary spontaneous pneumothorax (PSP) has long been contentious.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To identify the factors influencing interventional versus conservative management and to assess current practice patterns for moderate\u2010to\u2010large PSP in emergency department (ED) patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Anonymous online survey of emergency medicine, respiratory medicine and thoracic surgery specialists and trainees in Australia and New Zealand. Data collected included rating the decision\u2010making importance of potential drivers of interventional versus conservative management for PSP, initial management preference for stable patients with moderate\u2010large PSP based on three X\u2010ray\u2010based scenarios (one moderate\u2010large, 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 456 responses; 85.5% were from Australia. The most commonly reported factors influencing treatment decision\u2010making were vital signs (96.7%) and patient\u2010reported dyspnoea (84.3%). There was variation between specialty groups in initial treatment preference for all scenarios (<jats:italic>P<\/jats:italic> &lt;\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%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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\u2010based approach to PSP management in the ED that is widely understood and accepted across speciality groups and that prioritises patient symptoms over X\u2010ray findings.<\/jats:p><\/jats:sec>","DOI":"10.1111\/imj.70054","type":"journal-article","created":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T11:46:33Z","timestamp":1743507993000},"page":"944-950","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Current practice and attitudes in emergency department management of primary spontaneous pneumothorax in Australia and New Zealand: a scenario\u2010based\/survey"],"prefix":"10.1111","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4655-5023","authenticated-orcid":false,"given":"Anne\u2010Maree","family":"Kelly","sequence":"first","affiliation":[{"name":"Joseph Epstein Centre for Emergency Medicine Research at Western Health Sunshine Hospital  St Albans Victoria Australia"},{"name":"Australian Centre for Health Law Research Queensland University of Technology  Brisbane Queensland Australia"},{"name":"Critical Care \u2013 Melbourne Medical School The University of Melbourne  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjeevan","family":"Muruganandan","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine Northern Health  Melbourne Victoria Australia"},{"name":"Department of Medicine Melbourne Medical School, The University of Melbourne  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Jones","sequence":"additional","affiliation":[{"name":"Faculty of Health and Medical Sciences University of Auckland  Auckland New Zealand"},{"name":"Adult Emergency Department Auckland City Hospital  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1100-4552","authenticated-orcid":false,"given":"Gerben","family":"Keijzers","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Gold Coast Hospital and Health Service  Southport Queensland Australia"},{"name":"Faculty of Health Sciences and Medicine Bond University  Gold Coast Brisbane Australia"},{"name":"School of Medicine and Dentistry Griffith University  Southport Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran","family":"Kinnear","sequence":"additional","affiliation":[{"name":"Emergency and Children's Services The Prince Charles Hospital  Brisbane Queensland Australia"},{"name":"Department of Medicine University of Queensland  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Cameron","sequence":"additional","affiliation":[{"name":"Monash University School of Public Health and Preventive Medicine  Melbourne Victoria Australia"},{"name":"The Alfred Emergency &amp; 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