When should I consider referring a patient with a pneumothorax to seco

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Consider referring a patient with pneumothorax to secondary care for further management in the following situations:

If the pneumothorax is a tension pneumothorax causing life-threatening haemodynamic instability or severe respiratory compromise, urgent referral and chest decompression are required before imaging, ideally with open thoracostomy and chest drain insertion in hospital settings .
If the patient has an open pneumothorax, they should be referred for hospital management to cover the wound and monitor for tension pneumothorax development .
For any pneumothorax requiring chest decompression, referral to secondary care is necessary for definitive management with chest drain insertion .
Patients with pneumothorax who do not require immediate admission but have complications or uncertain diagnosis should be referred for urgent assessment .
Referral is also indicated if there is diagnostic uncertainty or if the pneumothorax is large or symptomatic and cannot be managed safely in primary care .

When should I consider referring a patient with a pneumothorax to secondary care for further management?