Document Detail


Risk factors for the misdiagnosis of pneumothorax in the intensive care unit.
MedLine Citation:
PMID:  2055079     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To identify risk factors predisposing to the misdiagnosis of pneumothorax in the ICU. DESIGN: A prospective case series investigation. SETTING: A medical ICU service of a military referral hospital. PATIENTS: All adult medical ICU patients were evaluated during a 12-month period. Of 464 admissions, 28 (6%) were found to have acquired a pneumothorax during their medical ICU stay. INTERVENTIONS: Nineteen (67.9%) patients with pneumothorax were diagnosed correctly on initial presentation of their pneumothorax. The remaining nine (32.1%) patients' pneumothoraces were misdiagnosed at initial presentation. MEASUREMENTS AND MAIN RESULTS: Tension pneumothorax occurred more frequently in patients with an initially misdiagnosed pneumothorax (33.3%) than in patients with pneumothoraces that were correctly diagnosed during their medical ICU stay (5.3%) (p less than .06). Thirteen variables chosen prospectively were examined using a chi-square statistic. The following four variables occurred statistically more often in nine patients with an initially misdiagnosed pneumothorax: a) mechanical ventilation required at the time of the development of pneumothorax (p less than .05); b) an atypical radiographic location of the pneumothorax (p less than .05); c) altered mental status exhibited at the time of pneumothorax presentation (p less than .05); and d) development of pneumothorax after peak physician staffing hours (p less than .02). CONCLUSIONS: Certain medical ICU patients appear to be at higher risk for the initial misdiagnosis of pneumothorax. Familiarity with factors predisposing to this problem should allow for a higher index of suspicion for the diagnosis of pneumothorax in critically ill patients and possibly improve the early detection of pneumothorax.
Authors:
M H Kollef
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Critical care medicine     Volume:  19     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  1991 Jul 
Date Detail:
Created Date:  1991-08-01     Completed Date:  1991-08-01     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  906-10     Citation Subset:  AIM; IM    
Affiliation:
Medical Intensive Care Unit, Fitzsimons Army Medical Center, Aurora, CO 80045-5001.
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MeSH Terms
Descriptor/Qualifier:
Causality
Diagnostic Errors
Female
Humans
Intensive Care Units*
Male
Medical Staff, Hospital / supply & distribution
Middle Aged
Orientation
Pneumothorax / diagnosis*,  epidemiology,  radiography
Prospective Studies
Respiration, Artificial / adverse effects

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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