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Systematic Reviews

, 3:3

First Online: 04 January 2014Received: 28 September 2013Accepted: 23 December 2013DOI: 10.1186-2046-4053-3-3

Cite this article as: Roberts, D.J., Leigh-Smith, S., Faris, P.D. et al. Syst Rev 2014 3: 3. doi:10.1186-2046-4053-3-3


BackgroundAlthough health care providers utilize classically described signs and symptoms to diagnose tension pneumothorax, available literature sources differ in their descriptions of its clinical manifestations. Moreover, while the clinical manifestations of tension pneumothorax have been suggested to differ among subjects of varying respiratory status, it remains unknown if these differences are supported by clinical evidence. Thus, the primary objective of this study is to systematically describe and contrast the clinical manifestations of tension pneumothorax among patients receiving positive pressure ventilation versus those who are breathing unassisted.

Methods-DesignWe will search electronic bibliographic databases MEDLINE, PubMed, EMBASE, and the Cochrane Database of Systematic Reviews and clinical trial registries from their first available date as well as personal files, identified review articles, and included article bibliographies. Two investigators will independently screen identified article titles and abstracts and select observational cohort, case–control, and cross-sectional studies and case reports and series that report original data on clinical manifestations of tension pneumothorax. These investigators will also independently assess risk of bias and extract data. Identified data on the clinical manifestations of tension pneumothorax will be stratified according to whether adult or pediatric study patients were receiving positive pressure ventilation or were breathing unassisted, as well as whether the two investigators independently agreed that the clinical condition of the study patients aligned with a previously published tension pneumothorax working definition. These data will then be summarized using a formal narrative synthesis alongside a meta-analysis of observational studies and then case reports and series where possible. Pooled or combined estimates of the occurrence rate of clinical manifestations will be calculated using random effects models for observational studies and generalized estimating equations adjusted for reported potential confounding factors for case reports and series.

DiscussionThis study will compile the world literature on tension pneumothorax and provide the first systematic description of the clinical manifestations of the disorder according to presenting patient respiratory status. It will also demonstrate a series of methods that may be used to address difficulties likely to be encountered during the conduct of a meta-analysis of data contained in published case reports and series. PROSPERO registration number: CRD42013005826.

KeywordsTension pneumothorax Clinical manifestations Systematic review Meta-analysis Observational study Rare conditions Case report Case series Case study AbbreviationsATLSAdvanced Trauma Life Support

FIO2Fraction of inspired oxygen

ICUIntensive care unit

MeSHMedical Subject Heading

PaO2Partial pressure of arterial oxygen

SpO2Arterial oxygen saturation.

Electronic supplementary materialThe online version of this article doi:10.1186-2046-4053-3-3 contains supplementary material, which is available to authorized users.

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Autor: Derek J Roberts - Simon Leigh-Smith - Peter D Faris - Chad G Ball - Helen Lee Robertson - Christopher Blackmore - Elijah


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