Methodology: 2/5
Usefulness: 3/5

Brown SGA, et al. N Engl J Med. 2020 Jan 30;382(5):405-415.

Question and Methods: Is conservative/observational treatment of moderate-large spontaneous pneumothorax non-inferior to chest tube insertion? Multicentre RCT at 39 hospitals in Australia and New Zealand.

Findings: Total of 316 patients. Re-expansion <8 weeks occurred in 129/131 (98.5%) of interventional vs. 118/125 (94.4%) of conservative group. Non-inferior in primary, but not in sensitivity analysis. Conservative management had less serious adverse events.

Limitations: Significant amount of missing data, unblinded study, large non-inferiority margin, and cross over in both groups.

Interpretation: In select patients with moderate-large primary spontaneous pneumothorax, conservative management may be non-inferior to pig-tail drainage with less adverse events.

By: Dr. Renee Bradley


  • Hans Rosenberg

    Dr. Rosenberg is an emergency physician at the Ottawa Hospital, assistant professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.

    View all posts