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Incidence of primary spontaneous pneumothorax: a validated, register-based nationwide study

Winnie Hedevang Olesen, Ingrid Louise Titlestad, Poul Erik Andersen, Rune Lindahl-Jacobsen, Peter Bjørn Licht
ERJ Open Research 2019 5: 00022-2019; DOI: 10.1183/23120541.00022-2019
Winnie Hedevang Olesen
1Dept of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
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  • For correspondence: winnie.olesen@rsyd.dk
Ingrid Louise Titlestad
2Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark
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Poul Erik Andersen
3Dept of Radiology, Odense University Hospital, Odense, Denmark
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Rune Lindahl-Jacobsen
4Danish Aging Research Center, Unit of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark
5Max Planck Odense Center on Biodemography of Aging, Odense, Denmark
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Peter Bjørn Licht
1Dept of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
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  • Article
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  • FIGURE 1
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    FIGURE 1

    Flowchart showing the selection of primary spontaneous pneumothorax (PSP) patients in the national cohort. DNPR: Danish National Patient Registry; PTX: pneumothorax; SSP: secondary spontaneous pneumothorax.

  • FIGURE 2
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    FIGURE 2

    Incidence rate (IR) per 100 000 by age, overall and divided by sex.

  • FIGURE 3
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    FIGURE 3

    Incidence rate (IR) per 100 000 per year, overall and divided by sex.

Tables

  • Figures
  • TABLE 1

    Explanation of how each diagnosis was assigned during the systematic read-through

    DiagnosisCriteria
    Spontaneous PTXOccurring with no apparent cause with or without tension
    PSP: occurring in otherwise healthy individuals
    SSP: occurring in patients with pre-existing lung-disorder
    We assigned tension PTX diagnosis if there was evidence in the chart
     both clinically and by chest radiography to support this diagnosis.
     PSP
     SSP
    Traumatic PTXOccurring as a direct result of trauma, including haemothorax
    Iatrogenic PTXOccurring unintentionally as a direct result of treatment, examination or surgery performed on the patient
    Perinatal/congenital PTXOccurring in relation to child birth or as a direct result of congenital disorders
    Isolated pneumomediastinumTypically occurring after extreme coughing or giving birth
    ThoracentesisSurgical puncture and drainage of the thoracic cavity, either diagnostic or as treatment
    EmpyemaA condition where pus collects in the pleural cavity
    MisclassificationSuspected PTX; however, this was disproved but the diagnosis was maintained and reported to the national database by mistake
    No apparent reason for PTXPatients where no apparent reason for their PTX diagnosis was identified, despite thorough examination of all charts from the year 2000 onwards
    Probably a PTX incident prior to the year 2000 or possibly misclassification

    PTX: Pneumothorax; PSP: primary spontaneous pneumothorax; SSP: secondary spontaneous pneumothorax.

    • TABLE 2

      Pneumothorax (PTX) diagnoses in the validation population

      PTX diagnosis (ICD code)ICD diagnosis
      ICD diagnosis applied originallyICD diagnosis after re-evaluation
      Spontaneous PTX 
       With tension (J93.0)17256
       Without tension (J93.1)491666
      Iatrogenic PTX 
       Post-surgery (J95.8A)14117
       Iatrogenic (T81.2)067
      Traumatic PTX (S.27.0)476490
      Other kinds of PTX (J93.8)150
      Unspecified PTX (J93.9)5990
      Misclassification036

      ICD: International Classification of Diseases.

      • TABLE 3

        Incidence rates (IRs) per 100 000 individuals of primary spontaneous pneumothorax in Denmark overall and stratified by sex

        VariablesOverallFemaleMale
        PatientsIR (95% CI)PatientsIR (95% CI)PatientsIR (95% CI)
        Age group      
         0–10 years000000
         11–15 years362.1 (1.5–2.9)20.2 (0.1–0.8)343.9 (2.8–5.5)
         16–20 years27815.6 (9.5–25.6)222.5 (1.6–3.8)25628.1 (24.9–31.8)
         21–25 years24214.2 (8.4–23.9)283.3 (2.3–4.8)21424.7 (21.6–28.2)
         26–30 years18211.5 (6.5–20.5)283.6 (2.5–5.2)15419.3 (16.5–22.6)
         31–35 years1669.6 (5.1–18.1)364.2 (3.0–5.8)13015.0 (12.6–17.8)
         36–40 years1246.5 (3.0–14.0)343.5 (2.5–4.9)909.3 (7.6–11.4)
         Overall10287.3 (6.9–7.8)1502.2 (1.9–2.6)87812.3 (11.5–13.1)
        Year
         2009–20101686.0 (5.2–6.9)261.9 (1.3–2.8)14210.0 (8.5–11.8)
         2010–20111967.0 (6.1–8.1)201.4 (0.9–2.2)17612.3 (10.6–14.3)
         2011–20121987.1 (6.2–8.2)382.8 (2.0–3.8)16011.2 (9.6–13.1)
         2012–20132488.7 (7.7–9.6)261.9 (1.3–2.8)22215.6 (13.7–17.8)
         2013–20142188.2 (7.2–9.4)402.9 (2.1–4.0)17812.5 (10.8–14.5)
      • TABLE 4

        Baseline characteristics of the 514 patients with primary spontaneous pneumothorax

        VariableOverallFemaleMale
        Patients51475 (15%)439 (85%)
        Age on first admission years
         Median (range)25 (12–40)29 (15–40)24 (12–40)
         Mean±sd25.7±7.129.2±7.225.1±6.9¶
        Lung affected initially
         Right lung256 (53%)36 (48%)220 (50%)
         Left lung254 (46%)37 (49%)217 (49%)
         Bilateral4 (1%)2 (3%)2 (1%)
        Body mass index kg·m−2
         Median (range)20.4 (12.7–33.2)20.4 (12.7–33.2)20.4 (13.9–29.2)
         Mean±sd#20.7±3.120.9±4.520.7±2.7
        Smoking habits
         Never-smokers136 (27%)22 (29%)114 (26%)
         Daily smokers299 (58%)36 (48%)263 (60%)
         Weekly smokers12 (2%)2 (3%)10 (2%)
         Less than weekly8 (1.5%)3 (4%)5 (1%)
         Ex-smokers21 (4%)8 (10%)13 (3%)
         Unknown36 (7%)4 (5%)32 (7%)

        #: n=225. ¶: p<0.0001.

        • TABLE 5

          Characteristics of the hospitalisations with primary spontaneous pneumothorax on first admission

          VariableOverallFemaleMale
          Patients51475 (15%)439 (85%)
          Characteristics at first onset 
           Sudden onset of symptoms490 (95%)68 (91%)422 (96%)
           Admitted to hospital within 24 h after onset385 (75%)46 (61%)339 (77%)
          Symptom onset during 
           Sleep82 (16%)11 (14%)71 (16%)
           Rest359 (70%)59 (79%)300 (68%)
           Normal activities of daily living56 (11%)5 (7%)51 (12%)
           Exercise17 (3%)017 (4%)
          Treatment facility at first admittance 
           Cardiothoracic centre99 (19%)14 (19%)85 (19%)
           General surgical/medical ward326 (64%)45 (60%)281 (64%)
           Referred from general ward to cardiothoracic centre89 (17%)16 (21%)73 (17%)
          Hospitalisation duration days 
           Median (range)4 (1–30)4 (1–20)4 (1–30)
           Mean±sd5.1±4.275.8±5.035.0±4.11
          Treatment on first admission 
           Initial treatment 
            Observation74 (14%)11 (15%)63 (14%)
            Chest tube with/without suction440 (86%)64 (85%)376 (86%)
           Surgical treatment performed during the first admission 
            VATS resection of blebs with partial pleurectomy or pleural   abrasion88 (17%)21 (28%)69 (16%)
            Resection of bullae by thoracotomy2 (0.5%)02 (0.5%)

          VATS: video-assisted thoracoscopic surgery.

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          Incidence of primary spontaneous pneumothorax: a validated, register-based nationwide study
          Winnie Hedevang Olesen, Ingrid Louise Titlestad, Poul Erik Andersen, Rune Lindahl-Jacobsen, Peter Bjørn Licht
          ERJ Open Research Apr 2019, 5 (2) 00022-2019; DOI: 10.1183/23120541.00022-2019

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          Incidence of primary spontaneous pneumothorax: a validated, register-based nationwide study
          Winnie Hedevang Olesen, Ingrid Louise Titlestad, Poul Erik Andersen, Rune Lindahl-Jacobsen, Peter Bjørn Licht
          ERJ Open Research Apr 2019, 5 (2) 00022-2019; DOI: 10.1183/23120541.00022-2019
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