Table 5.
Pooled chest drain insertion incidence and odds ratios based on risk factors
| Study # | Pneumothorax requiring chest drain | Odds ratio (95% CI) | I2 | |||
| Group A | Group B | |||||
| OPERATOR FACTORS | ||||||
| Training level: Attending (A) vs Resident (B) | 2 | 7.6% | 4.5% | 0.74 (0.30–1.87) | 35% | |
| Immediate evaluation by cytologist: Yes (A) vs No (B) | 1 | 6.4% | 4.5% | 1.43 (0.44–4.64) | - | |
| BIOSPY NEEDLE FACTORS | ||||||
| FNA (A) vs Automated core (B) | 3 | 12.5% | 13.3% | 0.99 (0.77–1.27) | 0% | |
| FNA (A) vs Manual core (B) | 1 | 10.8% | 9.8% | 1.11 (0.45–2.75) | - | |
| Non-coaxial (A) vs Coaxial (B) | 1 | 3.6% | 5.0% | 0.71 (0.33–1.52) | - | |
| Larger guide/Needle gauge: £18G (A) vs > 18G (B) | 3 | 16.1% | 11.7% | 1.39 (1.18–1.62)*** | 0% | |
| BIOPSY TECHNIQUE | ||||||
| Chest wall needle entry location: | ||||||
| Anterior (A) vs Posterior (B) | 1 | 20.4% | 11.6% | 1.94 (1.62–2.32)*** | - | |
| Anterior (A) vs Lateral (B) | 1 | 20.4% | 13.6% | 1.64 (1.24–2.15)*** | - | |
| Posterior (A) vs Lateral (B) | 1 | 11.6% | 13.6% | 0.84 (0.64–1.11) | - | |
| Needle angle: | ||||||
| £30 (A) vs > 30(B) degrees | 1 | 4.8% | 7.8% | 0.59 (0.17–1.98) | - | |
| £45 (A) vs > 45(B) degrees | 1 | 5.2% | 4.4% | 1.18 (0.58–2.38) | - | |
| Bulla crossed: Yes (A) vs No (B) | 1 | 18.3% | 1.9% | 11.04 (5.32–22.90)*** | - | |
| Fissure crossed: Yes (A) vs No (B) | 5 | 27.9% | 10.7% | 3.54 (2.32–5.40)*** | 39% | |
| Pleural punctures:>1 (A) vs 1 (B) | 2 | 7.8% | 4.5% | 1.25 (0.07–21.80) | 89%* | |
| Coaxial tissue samples: £2 (A) vs > 2 (B) | 1 | 2.0% | 3.3% | 0.61 (0.27–1.41) | - | |
| PATIENT FACTORS | ||||||
| Supine (A) vs Prone (B) | 4 | 5.4% | 3.3% | 1.54 (0.75–3.16) | 74%* | |
| Puncture site up (A) vs Site down + with aperture in CT Gantry table (B) | 1 | 18.0% | 2.7% | 7.84 (2.53–24.29)*** | - | |
| Prone or supine (A) vs Lateral decubitus position with biopsied lung down (B) | 1 | 5.4% | 4.2% | 1.30 (0.50–3.37) | - | |
| Interactive breath-hold: Yes (A) vs No (B) | 1 | 10% | 9.4% | 1.08 (0.50–2.33) | - | |
| Conscious sedation (A) vs Local anesthesia (B) | 1 | 7.8% | 6.8% | 1.16 (0.52–2.59) | - | |
| NON-MODIFIABLE FACTORS | ||||||
| Male (A) vs Female (B) | 5 | 11.0% | 9.5% | 1.11 (0.48–2.55) | 88%* | |
| Emphysema (A) vs No emphysema (B) | 4 | 27.2% | 8.8% | 6.44 (4.27–9.72)*** | 58% | |
| Upper/Middle lobe (A) vs Lower lobe (B) | 5 | 11% | 7.0% | 1.37 (0.90–2.10) | 70%* | |
| No pleural contact (A) vs Pleural contact (B) | 2 | 4.7% | 2.4% | 1.97 (1.21–3.21)** | 0% | |
CI, confidence interval.
a
p-value < 0.05; **p-value < 0.01, ***p-value < 0.001, 95% CI - 95% CI.