Contributor: Adam Barkin, MD

Educational Pearls:

• Multi-center open-label non-inferiority trial looked at treatment of pneumothorax with a small-bore chest tube versus conservative management with exceptional follow up
• 316 patients ages 14-50 with moderate to large pneumothorax (>32% measured on CXR) were randomized into one of the two treatment arms
• 15% of the conservative group required further intervention as determined by prespecified protocols
• 94.4% of the intervention group had resolution at 8 weeks, whereas 98.5% of the conservative group had resolution at 8 weeks
• • These data were affected by poor follow up
• CXR resolution average of 16 days in the intervention group and 30 days in the conservative group
• Symptom resolution was similar between the two groups (median 15 days vs. 14 days)
• Recurrence at 12 months was 17% in interventional group vs 8% in conservative group
• 41 adverse events in intervention group and 13 adverse events in conservative group

References

Brown SGA, Ball EL, Perrin K, et al. Conservative versus Interventional Treatment for Spontaneous Pneumothorax. N Engl J Med. 2020;382(5):405-415. doi:10.1056/NEJMoa1910775

Franzen, D. (2019, November). Pneumothorax. Society of Academic Emergency Medicine. https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-respiratory/pneumothorax.

Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD

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