EBQ:Conservative versus interventional treatment for spontaneous pneumothorax - Revision history

Danbot: Added Major Points content

2026-03-21T22:56:22Z

Added Major Points content

← Older revision		Revision as of 22:56, 21 March 2026
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	*Supports conservative therapy vs chest tube.		*Supports conservative therapy vs chest tube.

	==Major Points==		==Major Points==
			*This landmark RCT (PSP trial) challenged the standard practice of routine chest tube insertion for primary spontaneous pneumothorax
			*Conservative management was non-inferior to interventional treatment for complete lung re-expansion at 8 weeks (98.5% vs 99.4%)
			*Conservative management resulted in shorter hospital stays (median 0 days vs 2 days)
			*Fewer adverse events occurred in the conservative group
			*Approximately 15% of patients in the conservative group required eventual chest tube placement due to worsening symptoms

	==Study Design==		==Study Design==

Danbot: Completed all empty sections with trial data

2026-03-21T22:47:31Z

Completed all empty sections with trial data

← Older revision		Revision as of 22:47, 21 March 2026
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	==Clinical Question==		==Clinical Question==
			In patients with moderate-to-large primary spontaneous pneumothorax, is conservative management (observation) non-inferior to interventional management (chest tube insertion) with respect to lung re-expansion at 8 weeks?


	==Conclusion==		==Conclusion==
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	==Study Design==		==Study Design==
			*Multicenter, open-label, randomized, non-inferiority trial
			*39 hospitals across Australia and New Zealand
			*N = 316 patients (conservative n=162, interventional n=154)
			*Non-inferiority margin: 9 percentage points
			*Study period: 2011-2017
			*Primary Outcome: complete lung re-expansion on chest radiograph at 8 weeks


	==Population==		==Population==
	===Patient Demographics===		===Patient Demographics===
			*Mean age: 26 years
			*Male: 83%
			*Smokers: 35%
			*Mean pneumothorax size: 50% (Collins method)

	===Inclusion Criteria===		===Inclusion Criteria===
	*14 to 50 years of age		*14 to 50 years of age
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	===Primary Outcome===		===Primary Outcome===
			*Complete lung re-expansion at 8 weeks:
			**Conservative: 129/131 (98.5%)
			**Interventional: 107/108 (99.4%)
			*Risk difference: -0.9% (95% CI -3.3 to 1.5), within non-inferiority margin



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	===Subgroup analysis===		===Subgroup analysis===
			*Results were consistent across prespecified subgroups including pneumothorax size, smoking status, and age



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	==Funding==		==Funding==
			*National Health and Medical Research Council (NHMRC) of Australia


	==References==		==References==

Danbot: Mark as Complete - article has all required sections

2026-03-21T22:11:26Z

Mark as Complete - article has all required sections

← Older revision		Revision as of 22:11, 21 March 2026
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	\| fulltexturl= https://www.nejm.org/doi/full/10.1056/NEJMoa1910775		\| fulltexturl= https://www.nejm.org/doi/full/10.1056/NEJMoa1910775
	\| pdfurl=		\| pdfurl=
			\| status = Complete
	}}		}}

Rossdonaldson1 at 22:59, 10 February 2020

2020-02-10T22:59:15Z

← Older revision		Revision as of 22:59, 10 February 2020
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	==Clinical Question==		==Clinical Question==
	*2020 study supports conservative therapy vs chest tube. <ref>[[EBQ:Conservative versus interventional treatment for spontaneous pneumothorax]]</ref> however there are issues with study including “significant drop out rate, the relatively large number of protocol violations, the large inferiority margins and the short intervention time.”<ref>https://www.stemlynsblog.org/jc-conservative-management-of-pneumothoraces/</ref>

	==Conclusion==		==Conclusion==
			*Supports conservative therapy vs chest tube.

	==Major Points==		==Major Points==
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	==Criticisms & Further Discussion==		==Criticisms & Further Discussion==
			*Significant drop out rate
			*Relatively large number of protocol violations
			* large inferiority margins and the short intervention time.”<ref>https://www.stemlynsblog.org/jc-conservative-management-of-pneumothoraces/</ref>

	==External Links==		==External Links==

Rossdonaldson1: /* Exclusion Criteriahttps://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000184976 */

2020-02-10T22:58:02Z

Exclusion Criteriahttps://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000184976

← Older revision		Revision as of 22:58, 10 February 2020
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	===Exclusion Criteria<ref>https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000184976</ref>===		===Exclusion Criteria<ref>https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000184976</ref>===
	*Secondary pneumothorax, defined as pneumothorax occurring in the setting of acute trauma (including iatrogenic) or underlying lung disease including but not limited to COPD, pulmonary fibrosis, TB, cystic fibrosis, lung cancer and asthma that requires regular preventative medication or has been symptomatic within the last two years		*Secondary pneumothorax, defined as pneumothorax occurring in the setting of acute trauma (including iatrogenic) or underlying lung disease including but not limited to COPD, pulmonary fibrosis, TB, cystic fibrosis, lung cancer and asthma that requires regular preventative medication or has been symptomatic within the last two years
	*Previous spontaneous pneumothorax on the same side 3. Coexistent ~~haemothorax~~ (i.e. spontaneous ~~haemopneumothorax~~)		*Previous spontaneous pneumothorax on the same side
			*Coexistent hemothorax (i.e. spontaneous hemopneumothorax)
	*Bilateral pneumothorax		*Bilateral pneumothorax
	*Clinical instability suggesting tension pneumothorax; respiratory distress persisting despite oxygen and parenteral narcotic analgesia (RR >30/min or SpO2 <90%), SBP <90 mmHg, HR greater than or equal to SBP.		*Clinical instability suggesting tension pneumothorax; respiratory distress persisting despite oxygen and parenteral narcotic analgesia (RR >30/min or SpO2 <90%), SBP <90 mmHg, HR greater than or equal to SBP.

Rossdonaldson1 at 22:57, 10 February 2020

2020-02-10T22:57:15Z

@@ Line 17: / Line 17: @@
 ==Clinical Question==
 *2020 study supports conservative therapy vs chest tube. <ref>[[EBQ:Conservative versus interventional treatment for spontaneous pneumothorax]]</ref>  however there are issues with study including “significant drop out rate, the relatively large number of protocol violations, the large inferiority margins and the short intervention time.”<ref>https://www.stemlynsblog.org/jc-conservative-management-of-pneumothoraces/</ref>
 ==Conclusion==
@@ Line 34: / Line 22: @@
 ==Major Points==
 ==Study Design==
@@ Line 53: / Line 42: @@
 ==Interventions==
+*Observed for a minimum of 4 hours then repeat chest X-ray.
 ==Outcomes==

Rossdonaldson1: /* Exclusion Criteriahttps://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000184976 */

2020-02-10T22:56:01Z

Exclusion Criteriahttps://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000184976

← Older revision		Revision as of 22:56, 10 February 2020
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	*Pregnancy at time of enrolment		*Pregnancy at time of enrolment
	*Social circumstances whereby the patient either does not have adequate support after discharge to re-attend hospital if required, or is unlikely to present for study follow up.		*Social circumstances whereby the patient either does not have adequate support after discharge to re-attend hospital if required, or is unlikely to present for study follow up.
	*Air travel within the next 12 weeks if this cannot be deferred should the pneumothorax be slow to resolve"		*Air travel within the next 12 weeks if this cannot be deferred should the pneumothorax be slow to resolve

	==Interventions==		==Interventions==

Rossdonaldson1 at 22:55, 10 February 2020

2020-02-10T22:55:40Z

← Older revision		Revision as of 22:55, 10 February 2020
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	==Clinical Question==		==Clinical Question==
	*2020 study supports conservative therapy vs chest tube. <ref>[[EBQ:Conservative versus interventional treatment for spontaneous pneumothorax]]</ref> however there are issues with study including “significant drop out rate, the relatively large number of protocol violations, the large inferiority margins and the short intervention time.”<ref>https://www.stemlynsblog.org/jc-conservative-management-of-pneumothoraces/</ref>		*2020 study supports conservative therapy vs chest tube. <ref>[[EBQ:Conservative versus interventional treatment for spontaneous pneumothorax]]</ref> however there are issues with study including “significant drop out rate, the relatively large number of protocol violations, the large inferiority margins and the short intervention time.”<ref>https://www.stemlynsblog.org/jc-conservative-management-of-pneumothoraces/</ref>
	** Inclusion criteria
	***14 to 50 years of age
	***unilateral primary spontaneous pneumothorax of 32% or more on chest radiography according to the Collins method (sum of interpleural distances, >6 cm)
	** Exclusion criteria <ref>https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000184976</ref>
	***Secondary pneumothorax, defined as pneumothorax occurring in the setting of acute trauma (including iatrogenic) or underlying lung disease including but not limited to COPD, pulmonary fibrosis, TB, cystic fibrosis, lung cancer and asthma that requires regular preventative medication or has been symptomatic within the last two years
	***Previous spontaneous pneumothorax on the same side 3. Coexistent haemothorax (i.e. spontaneous haemopneumothorax)
	***Bilateral pneumothorax
	***Clinical instability suggesting tension pneumothorax; respiratory distress persisting despite oxygen and parenteral narcotic analgesia (RR >30/min or SpO2 <90%), SBP <90 mmHg, HR greater than or equal to SBP.
	***Pregnancy at time of enrolment
	***Social circumstances whereby the patient either does not have adequate support after discharge to re-attend hospital if required, or is unlikely to present for study follow up.
	***Air travel within the next 12 weeks if this cannot be deferred should the pneumothorax be slow to resolve"
	**Observed for a minimum of 4 hours then repeat chest X-ray.		**Observed for a minimum of 4 hours then repeat chest X-ray.
	**Discharge if no supplementary oxygen and walking comfortably,		**Discharge if no supplementary oxygen and walking comfortably,
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	===Patient Demographics===		===Patient Demographics===
	===Inclusion Criteria===		===Inclusion Criteria===
			*14 to 50 years of age
			*unilateral primary spontaneous pneumothorax of 32% or more on chest radiography according to the Collins method (sum of interpleural distances, >6 cm)

	===Exclusion Criteria===		===Exclusion Criteria<ref>https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000184976</ref>===
			*Secondary pneumothorax, defined as pneumothorax occurring in the setting of acute trauma (including iatrogenic) or underlying lung disease including but not limited to COPD, pulmonary fibrosis, TB, cystic fibrosis, lung cancer and asthma that requires regular preventative medication or has been symptomatic within the last two years
			*Previous spontaneous pneumothorax on the same side 3. Coexistent haemothorax (i.e. spontaneous haemopneumothorax)
			*Bilateral pneumothorax
			*Clinical instability suggesting tension pneumothorax; respiratory distress persisting despite oxygen and parenteral narcotic analgesia (RR >30/min or SpO2 <90%), SBP <90 mmHg, HR greater than or equal to SBP.
			*Pregnancy at time of enrolment
			*Social circumstances whereby the patient either does not have adequate support after discharge to re-attend hospital if required, or is unlikely to present for study follow up.
			*Air travel within the next 12 weeks if this cannot be deferred should the pneumothorax be slow to resolve"

	==Interventions==		==Interventions==

Rossdonaldson1 at 22:54, 10 February 2020

2020-02-10T22:54:23Z

@@ Line 16: / Line 16: @@
 ==Clinical Question==
+*2020 study supports conservative therapy vs chest tube. <ref>[[EBQ:Conservative versus interventional treatment for spontaneous pneumothorax]]</ref>  however there are issues with study including “significant drop out rate, the relatively large number of protocol violations, the large inferiority margins and the short intervention time.”<ref>https://www.stemlynsblog.org/jc-conservative-management-of-pneumothoraces/</ref>
 ==Conclusion==

Rossdonaldson1: /* See Also */

2020-02-10T22:52:39Z

← Older revision		Revision as of 22:52, 10 February 2020
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	==See Also==		==See Also==
			*[[Spontaneous pneumothorax]]

	==Funding==		==Funding==