Pleural disease · Primary spontaneous pneumothorax
Randomised Ambulatory Management of Primary Pneumothorax
| Design | Open-label randomised controlled trial |
|---|---|
| Treatment | Ambulatory management with a one-way valve device |
| Control | Standard care per guidelines |
| Population | 236 patients with primary spontaneous pneumothorax, from 776 screened |
| Follow-up | 30 days |
| Primary endpoint | Total length of hospital stay including re-admission in the first 30 days |
| Result | Median hospitalisation 0 days (IQR 0-3) with ambulatory care versus 4 days (IQR 0-8) with standard care (p<0.0001, median difference 2 days, 95% CI 1 to 3). Adverse events occurred in 64 of 117 (55%) ambulatory patients versus 46 of 119 (39%) standard care patients. |
| Secondary endpoints | Adverse events, serious adverse events, re-intervention |
Ambulatory management of primary spontaneous pneumothorax significantly reduced the duration of hospitalisation including re-admissions in the first 30 days, but at the expense of increased adverse events.
The trial authors, in the published abstract
A genuine trade-off rather than a win: four hospital days saved against a 16 percentage point excess of adverse events. Read alongside PSP — between them, the modern algorithm is observe first, and use an ambulatory device for those who need drainage.
Hallifax RJ, McKeown E, Sivakumar P, et al. Ambulatory management of primary spontaneous pneumothorax: an open-label, randomised controlled trial. Lancet 2020 Jul 4;396(10243):39-49.