Pigtail catheters versus large-bore chest tubes for pneumothoraces in children treated in the emergency department.

OBJECTIVE: We sought to compare the efficacy (pneumothorax resolution and hospitalization days), pain (narcotic usage), and safety (need for repositioning or replacement) associated with placement of large-bore chest tubes versus pigtail catheters in children with pneumothoraces.

METHODS: We conducted a retrospective chart review of all patients with pneumothoraces seen in the emergency department (ED) over a 6.5-year period who received treatment by a pediatric emergency physician with either a large-bore chest tube or a pigtail catheter. We excluded patients who had catheters placed by other specialists and patients who were endotracheally intubated. We collected the following data: complications, hospital days to discharge, and narcotic pain medications taken.

RESULTS: Eleven pigtail catheters and 16 large-bore chest tubes were placed. All pneumothoraces were effectively evacuated. Three of the 11 pigtail catheters required repositioning, and one was replaced. Two of the 16 large-bore chest tubes were repositioned, and one was replaced; additionally, a pigtail catheter was added to one patient with a large-bore chest tube to facilitate evacuation of the air. Average hospital stay was similar between groups (6.2 d for pigtail catheters vs 6.8 d for large-bore chest tubes, = 0.74). Children with pigtail catheters required less narcotic pain medications than those who had large-bore chest tubes, but the differences were not significant.

CONCLUSION: Pigtail catheters offer a safe and effective alternative to large-bore chest tubes for patients receiving treatment for pneumothoraces in the ED.