Evidence review summary for ‘What is the best acute management for spontaneous pneumothorax?’
| Clinical outcomes | Summary of evidence review (treatment vs ICD) (95% CI) | ||||
| (Treatment) | Conservative management | NA | Ambulatory management | Chemical pleurodesis | Thoracic surgery |
| LOS | Shortened LOS with conservative management* | 2.55 days shorter (2.24 to 2.87) with NA (PSP)† | 3.47 days shorter (2.20 to 4.73) with ambulatory management† | No difference | No difference |
| Pneumothorax recurrence | Lesser risk with conservative management (111/1000 (80 to 155)) compared with (179/1000)† | No difference | No difference | Lesser risk with chemical pleurodesis (179/1000 (138 to 227)) compared with 320/100 (PSP and SSP)† | Lesser risk with thoracic surgery (54/1000 (36 to 80)) compared with 298/1000 (PSP and SSP)† |
| Re-admission | Not enough evidence | Not reported | No difference | Not reported | Not reported |
| Need for further pleural procedures | Not enough evidence | Greater need with NA (626/1000 (544 to 719) compared with 240/1000 | No difference | Not reported | Not reported |
| Complications | Reduced post-treatment complications with conservative management* | No overall difference in complications, but may be an reduction in subcutaneous emphysema following NA (9/1000 (1 to 70) compared with 92/1000) | No difference | Not enough evidence | No difference |
| Pain and breathlessness | Not enough evidence | Not enough evidence | Not enough evidence | Greater need for opioids with chemical pleurodesis* | Not reported |
| Quality of life | Not enough evidence | Not reported | Not reported | Not reported | Not reported |
| Mortality | Not reported | Not reported | Not reported | Not reported | No difference |
*Meta-analysis not possible, data reported in different formats.
†Meta-analysis results reported as per 1000 patients.
ICD, intercostal drainage; LOS, length of stay; NA, needle aspiration; PSP, primary spontaneous pneumothorax; SSP, secondary spontaneous pneumothorax.