Spontaneous pneumothorax.
BACKGROUND
The incidence of spontaneous pneumothorax is 24/100,000 a year in men and 9.9/100,000 in women in England and Wales. The major contributing factor is smoking, which increases the likelihood by 22 times in men, and by 8 times in women. While death from spontaneous pneumothorax is rare, rates of recurrence are high, with one study of men in the US finding a total recurrence rate of 35%.


METHODS
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments in people presenting with spontaneous pneumothorax? What are the effects of interventions to prevent recurrence in people with previous spontaneous pneumothorax? We searched: Medline, Embase, The Cochrane Library and other important databases up to April 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).


RESULTS
We found 16 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.


CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: chest-tube drainage (alone or plus suction), chest tubes (small, standard sizes, one-way valves), needle aspiration, and pleurodesis.
Wakai
Abel
A
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
D015505:Chest Tubes; D004322:Drainage; D006801:Humans; D018700:Pleurodesis; D011030:Pneumothorax / Q000628:therapy; D011446:Prospective Studies; D012008:Recurrence; D012907:Smoking; D013396:Suction