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Adopting a Pico(t) Framework and Evidence To Develop Care Practices

Pneumothorax diagnosis requires a blend of expertise, knowledge, and abilities. The most vulnerable patients are those with a smoking history, chest injuries, or lung diseases. Shortness of breath, trauma. Fast breathing and sudden onset of chest pain are common symptoms of the condition (Hosseini-Nik et al., 2021). PICO(T), which stands for Population, Intervention, Comparison, Outcome, and Time, is a study framework that is helpful when developing patient care procedures. When done properly, this can be quite helpful in developing a care plan for the specified issue using evidence-based treatments, and in this context, pneumothorax. The following assessment adopts the PICO(T) framework to determine the most effective diagnosis and treatment approaches for pneumothorax.

Adopting the PICO(T) Approach to Diagnose and Treat Pneumothorax

Pneumothorax is a crucial diagnosis for medical professionals to establish, which can be life-threatening. Pneumothorax affects people of all ages; thus, medical workers should keep an elevated threshold of scepticism in patients who develop ipsilateral chest pain and rapid acute respiratory distress. It refers to the entry of air into the area between the visceral and parietal pleura. This can happen due to trauma to the pleura or interference in the lung tissue. Before they gain the necessary experience to competently diagnose and treat pneumothorax, newly licensed nurses may need to rely on the knowledge of senior nurses and doctors. The PICOT Question for the study is: In adult patients with suspected pneumothorax, does the use of chest X-ray (in comparison to other methods such as CT scan) result in accurate diagnosis and proper treatment initiation in emergency departments within the first 24 hours after the presentation?

The intervention selected for the study utilizes chest X-ray (compared to other approaches such as CT scan) to determine whether it generates a more accurate diagnosis and appropriate pneumothorax management. The population in the study is adult patients in emergency departments. The study’s objective is accurate diagnosis and appropriate treatment initiation for pneumothorax.

Identification of Sources of Evidence

Randomized Controlled trials

In clinical research, randomized controlled trials (RCTs) are thought to provide the strongest level of evidence for establishing causal relationships. The randomized control trial by Susarte et al. (2018) evaluates the finest scientific evidence available to establish the most effective way of diagnosing pneumothorax. According to the study, the posteroanterior chest radiography technique obtained during expiration has been used for numerous years because various authorities suggested it in classical thoracic radiology, including Greene and Felson. To evaluate the entire thoracic pathology initially, chest radiography with posteroanterior and lateral projections, taken while inhaling deeply, is the recommended technique.

Another RCT adopted in the study was published by Ulutas et al. (2022), discussing how spontaneous pneumothorax is a COVID-19 complication and how timely diagnosis and treatment will regulate mortality and morbidity. The study also adopts an RCT by Hosseini-Nik et al. (2021) examining the diagnostic precision of limited chest ultrasound in comparison to chest X-ray, which is the reference standard.

Systematic Review

High-quality systematic reviews are perceived as the most reliable evidence sources guiding clinical practice. One of the sources for this study is a systematic review by Ciriaco (2022), addressing spontaneous pneumothorax, analyzing various high-quality scientific studies to develop a common thread extending from the etiology to the management of the condition. The study also discusses the various management approaches for spontaneous pneumothorax, highlighting the potential of providing video-assisted thoracoscopic surgery (VATS) for each initial occurrence of primary spontaneous pneumothorax (PSP).


Meta-Analyses also provide the highest level of evidence in clinical practice. The study adopts a meta-analysis developed by Sajadi-Ernazarova et al. (2022), which addresses the various methods of diagnosis and management of pneumothorax. The study also discusses the interprofessional team’s responsibility in treating the ailment. According to the study, a thorough history, physical examination, and chest X-rays serve as the cornerstones of the diagnosis. The chest X-ray and physical examination frequently miss minor pneumothoraces; however, a CT chest scan taken as part of a diagnostic investigation for another injury may reveal them.

Findings from the Articles

The article developed by Sajadi-Ernazaova et al. (2022) addresses the diagnosis and treatment of acute pneumothorax, highlighting the chest-Xray method as the most preferred method currently, even though a CT chest scan can improve diagnostic accuracy. The study also discusses the interprofessional team’s responsibility in treating the ailment. Another article by Susarte et al. (2018) reveals that the posteroanterior chest radiography technique obtained during expiration has been used for numerous years, making it more popular. However, the most effective diagnostic technique is chest radiography with posteroanterior and lateral projections, taken while inhaling deeply.

The study by Ulutas et al. (2022) reveals that pneumothorax may be a complication of COVID-19 infection and that pneumothorax may be the only cause of hospitalization during COVID-19 medical treatment. The study also lays emphasis on the importance of timely diagnosis and treatment in regulating mortality and morbidity. The research by Hosseini-Nik et al. (2021) establishes that limited chest ultrasound is a viable replacement for chest X-rays. However, the study has a limitation of all assessments being conducted by one radiologist, preventing the assessment of inter-observer variation. The study by Ciriaco (2022) reveals that SSP occurs more commonly compared to PSP, making up 60 per cent of pneumothoraces. The secondary spontaneous pneumothorax (SSP) results are more detrimental than primary spontaneous pneumothorax (PSP), resulting in increased reoccurrence and longer hospital stays.

Relevance of the Findings

The studies adopted were relevant because they examined the different types of pneumothorax diagnosis approaches, intending to establish the most effective technique, except the study by Ciriaco (2022). The studies also offer suggestions for best-managing patients suffering from the condition to reduce morbidity and mortality rates. The effects of every intervention are examined, highlighting their efficacy levels and how to improve practice based on available evidence. The studies have also been established to be high-quality sources of evidence, published by reputable journals and qualified authors, and their findings are up-to-date.


The PICO(T) technique was adopted to establish the effectiveness of chest X-ray in diagnosing pneumothorax (in comparison to other approaches such as CT scans) within the first 24 hours and the best way to offer treatment to vulnerable patients. The articles adopted in the research were examined for relevance and established to provide high-quality, evidence-based best practices.


Ciriaco, P. (2022). Special Issue on “Clinical Research of Spontaneous Pneumothorax”. Journal

of Clinical Medicine11(11), 2988.

Hosseini-Nik, H., Bayanati, H., Souza, C. A., Gupta, A., McInnes, M. D., Pena, E., … & Dennie,

  1. (2022). Limited chest ultrasound to replace CXR in the diagnosis of pneumothorax post image-guided transthoracic interventions. Canadian Association of Radiologists Journal73(2), 403–409.

Sajadi-Ernazarova, K. R., Martin, J., & Gupta, N. (2022). Acute pneumothorax evaluation and

treatment. StatPearls.

Susarte, C. I., Gonzalez, A. S., & Martinez, P. (2018). Should a chest X-ray be performed as a

First imaging test on inspiration or expiration if pneumothorax is suspected? Elsevier, 60(5), 437–440. DOI: 10.1016/j.rx.2017.10.004

Ulutas, H., Celik, M. R., Gulcek, I., Kalkan, M., Agar, M., Kilic, T., & Gulcek, E. (2022).

Management of spontaneous pneumothorax in patients with COVID-19. Interactive cardiovascular and thoracic surgery34(6), 1002-1010.


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