A topic in Clinical Evidence 1 summarizes the results of three RCTs. The first RCT (n=73) found that fewer people had immediate resolution with aspiration (80%) than with chest tube drainage (100%), but that people receiving needle aspiration spent fewer days in hospital (3.2 days vs 5.3 days, p=0.005).The second RCT (n=61) found that pneumothorax resolved less frequently (67%) with needle aspiration than with tube drainage (93%) at 24 hours. There was no significant difference in recurrence at 3 months (18% with aspiration vs 25% with tube drainage). The third RCT (n=60) found no difference in immediate resolution rates (59% vs 64%) or hospital stay (3.5 days vs. 4.5 days).
A Cochrane review [Abstract] 2 included 1 study with a total of 60 subjects. There was no difference in immediate success rate of simple aspiration when compared with intercostal tube drainage (RR 0.93; 95% CI 0.62 to 1.40). There was no significant difference in the early failure rate between the two interventions: RR 1.12 (95% CI 0.59 to 2.13). Simple aspiration reduced the proportion of patients hospitalized (RR = 0.52; 95% CI 0.36 to 0.75).
A systematic review 3 including 3 RCTs was abstracted in DARE, involving a total of 270 subjects with unilateral, primary spontaneous pneumothorax. There was no significant difference between needle aspiration and tube thoracostomy in terms of immediate failure or risk of complication. Needle aspiration significantly reduced the need for hospital admission as compared to thoracostomy (2 trials, n=197: RR 0.26, 95% CI 0.17 to 0.39; RR 0.51, 95% CI 0.36 to 0.74). One-week failure rates were comparable between the two intervention groups (RR 0.86, 95% CI: 0.34, 2.18; RR 0.49, 95% CI: 0.10, 2.33). Overall, needle aspiration resulted in a shorter hospital stay. There was no significant difference in 1-year recurrence rates.
Comment: The quality of evidence was downgraded by inconsistency of results across studies.
Primary/Secondary Keywords