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Pleural disease is a group of conditions that affect the membrane around the lungs. These conditions-fluid around the lungs, infections, cancer, and collapsed lung-are common and can cause serious illness. They often lead to long hospital stays, emergency admissions, and reduced quality of life. In Denmark and worldwide, the number of patients with pleural disease is rising, and the treatment is costly for the healthcare system.
How long patients stay in the hospital depends on the type of pleural disease. Some stay less than a week, while others remain for several weeks, especially if complications occur. Research shows that early diagnosis and treatment based on clinical guidelines can shorten hospital stays and improve outcomes.
In the UK, many hospitals have created dedicated pleural clinics run by specialists. These clinics help ensure that patients receive fast, consistent, and evidence based care, and they have reduced the number of days patients spend in hospital. In Denmark, however, such clinics are rare. A recent national survey showed that many Danish hospitals do not follow current pleural disease guidelines, and many lack clear pathways for diagnosing and treating these patients. As a result, patients may receive suboptimal care.
This project aims to close that gap. The goal is to develop an easy to use, guideline based decision tool that supports doctors in emergency, medical, and surgical departments. The tool will guide clinicians from the moment a patient arrives until discharge, helping them choose the right tests and treatments at the right time. By making expert knowledge accessible to non specialists, the project hopes to improve patient care, reduce complications, and shorten hospital stays.
Ultimately, the project seeks to ensure that all patients with pleural disease in Denmark receive fast, safe, and evidence based treatment-no matter where they are admitted.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Usual care | Active Comparator | Usual provided care for patients with spontaneous pneumothorax, pleural effusion or pleural infection. All clusters begin in this condition before transitioning to the intervention as part of the stepped-wedge schedule. |
|
| Clinical decision-making support tool | Experimental | Care supported by the clinical decision-making app. Clusters transition to this condition at predefined time points according to the stepped-wedge design. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Clinical decision-making support tool | Behavioral | Care for patients with spontaneous pneumothorax, pleural effusion or pleural infection when supported by a clinical decision-support tool, in the form of a smartphone app. |
| Measure | Description | Time Frame |
|---|---|---|
| Length of hospital stay (days) | Number of days from hospital admission to hospital discharge. | From hospital admission through hospital discharge (up to 90 days) |
| Measure | Description | Time Frame |
|---|---|---|
| Correct pneumothorax subtype classification | Whether the pneumothorax subtype was correctly classified during the index hospital admission according to predefined diagnostic criteria (yes/no). | During index hospital admission (up to 90 days after admission) |
| Number of participants receiving each initial pneumothorax management strategy |
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Inclusion Criteria:
One or more of the following, relevante ICD-10 codes for either spontaneous pneumothorax, pleural effusion or pleural infection.
Spontaneous pneumothorax:
Pleural effusion:
Pleural infection:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Casper Jensen, MD | Lungemedicinsk Forskningsenhed (PLUZ), Institut for Regional Sundhedsforskning, Syddansk Universitet | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Aalborg University Hospital | Aalborg | 9000 | Denmark | |||
| Aarhus University Hospital |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Apr 13, 2026 |
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Stepped-wedge cluster-randomized controlled trial. All clusters begin in the control condition and cross over to the intervention at randomized time points.
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| Usual care | Other | Care supported by a clinical decision-support tool delivered via a smartphone app. |
|
Number of participants managed with either conservative care, needle aspiration, chest tube insertion, or ambulatory device insertion |
| Within 24 hours from hospital admission |
| Chest tube size | Diameter of chest tube used for treatment of spontaneous pneumothorax, reported in French units (Fr). | Periprocedural. |
| Number of participants with persistent air leak (>7 days) | Number of participants with ongoing air leak through the chest drainage system for more than 7 days after chest tube insertion (yes/no) | From chest tube insertion until resolution of air leak or up to 90 days |
| Number of participants undergoing high-resolution computed tomography (HRCT) | Number of participants who underwent high-resolution computed tomography (HRCT) during hospital admission or within 90 days after discharge, recorded as yes/no | During index hospital admission |
| Number of participants receiving complete recommended diagnostic work-up for unilateral pleural effusion | Assessment of whether recommended blood tests (full blood count, C-reactive protein, renal function tests, liver function tests, and albumin) and pleural fluid analyses (pH or glucose, LDH, leukocyte differential count, microbiology culture and sensitivity analysis, and cytology) were performed in participants with unilateral pleural effusion. | At end of index hospital admission (up to 90 days). |
| Chest tube size | Chest tube size (French gauge, Fr) used for pleural effusion drainage | Periprocedural |
| Definitive cause for pleural effusion | Was a definitive cause for the cause of pleural effusion established. | During hospital admission or within 90 days after discharge. |
| Definitive pleural procedure | Definitive pleural procedure within 90 days of admission due to pleural effusion. | During hospital admission or within 90 days after discharge. |
| Number of participants receiving complete recommended diagnostic work-up for suspected pleural infection | Assessment of whether recommended blood tests (full blood count, C-reactive protein, renal function tests, liver function tests, and albumin) and pleural fluid analyses (pH or glucose, LDH, leukocyte differential count, microbiology culture and sensitivity analysis, and cytology) were performed in participants with suspected pleural infection. | Up to 90 days |
| Chest tube diameter of chest tubes used for pleural infection. | Diameter of chest tube used for drainage of pleural infection, reported in French units (Fr). | Periprocedural. |
| Number of participants receiving intrapleural enzyme therapy (IET) for pleural infection. | Assessment of whether intrapleural enzyme therapy (IET) was administered in participants with pleural infection despite chest tube drainage. | Up to 90 days. |
| Length of antibiotic treatment | Total length of antibiotic treatment (both intravenously and orally) for pleural infection. | During hospital admission or within 90 days after discharge. |
| Aarhus |
| 8200 |
| Denmark |
| Amager Hospital | Amager | 2300 | Denmark |
| Esbjerg Hospital | Esbjerg | 6700 | Denmark |
| North Zealand Hospital, Hillerød | Hillerød | 3400 | Denmark |
| Hvidovre Hospital | Hvidovre | 2650 | Denmark |
| Kolding Hospital | Kolding | 6000 | Denmark |
| Zealand University Hospital, Køge | Køge | 4600 | Denmark |
| Odense University Hospital | Odense | 5000 | Denmark |
| Slagelse Hospital | Slagelse | 4200 | Denmark |
| Apr 13, 2026 |
| Prot_SAP_000.pdf |
| ID | Term |
|---|---|
| D010995 | Pleural Diseases |
| D011030 | Pneumothorax |
| D010996 | Pleural Effusion |
| ID | Term |
|---|---|
| D012140 | Respiratory Tract Diseases |
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