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