. 2017 Sep 7;2017(9):CD004479. doi: 10.1002/14651858.CD004479.pub3

Summary of findings for the main comparison. Simple aspiration compared with intercostal tube drainage for primary spontaneous pneumothorax.

Simple aspiration compared with intercostal tube drainage for primary spontaneous pneumothorax
Patient or population: adults with primary spontaneous pneumothorax Settings: university teaching hospitals, tertiary care hospitals, and general hospitals  Intervention: simple aspiration  Comparison: intercostal tube drainage
Outcomes	Illustrative comparative risks (95% CI)		Relative effect  (95% CI)	No. of participants  (studies)	Quality of the evidence  (GRADE)	Comments
Outcomes	Intercostal tube drainage	Simple aspiration	Relative effect  (95% CI)	No. of participants  (studies)	Quality of the evidence  (GRADE)	Comments
Immediate success rate  Follow‐up: 3 days to 24 months	714 per 1000	557 per 1000  (493 to 635)	RR 0.78   (0.69 to 0.89)	435  (6 studies)	⊕⊕⊕⊝  moderate^a
One‐year success rate  Follow‐up: 12 to 24 months	766 per 1000	820 per 1000  (735 to 904)	RR 1.07   (0.96 to 1.18)	318  (4 studies)	⊕⊕⊕⊝  moderate^a
Hospitalization rate  Follow‐up: 3 days to 24 months	862 per 1000	517 per 1000  (215 to 1000)	RR 0.60   (0.25 to 1.47)	245  (3 studies)	⊕⊝⊝⊝  very low^a,b,c
Duration of hospital stay   Follow‐up: 12 to 24 months	Mean duration of hospital stay ranged across control groups from 4.04 to 7 days.	Mean duration of hospital stay in the intervention groups was 1.66 lower (‐2.28 to ‐1.04).	—	387  (5 studies)	⊕⊕⊕⊝  moderate^a
Adverse events  Follow‐up: 3 days to 24 months	Overall, fewer adverse events occurred when patients were treated by simple aspiration than by tube drainage, including lesser perceived pain and lower pain scores, reduced need for thoracoscopic pleurodesis, and fewer technical adverse events (e.g. tube blockage when treated by tube drainage).		Not estimable	245  (3 studies)	⊕⊕⊝⊝  low^a,d
Cost‐effectiveness  Not reported	See comment.	See comment.	Not estimable	‐	See comment.	No studies reported cost‐effectiveness data.
Patient satisfaction  Follow‐up: mean 3 days	Median patient satisfaction among those treated with intercostal tube drainage was 8 on a visual analogue scale of 1 to 10 (Interquartile range 6.25 to 9.00), and median patient satisfaction among those treated by simple aspiration was 0.5 points lower (Interquartile range 5.00 to 9.00).			48  (1 study)	⊕⊕⊝⊝  low^a,e
CI: confidence interval; RR: risk ratio
GRADE Working Group grades of evidence  High quality: Further research is very unlikely to change our confidence in the estimate of effect.  Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.  Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.  Very low quality: We are very uncertain about the estimate.

^aResults for all outcomes downgraded one level as a result of study and/or reporting limitations, specifically, the large number of unclear or high risks of bias in the presented studies.

^bDowngraded one level as a result of significant heterogeneity (I² = 91%).  ^cDowngraded one level as a result of imprecision: low numbers of events and large confidence intervals.  ^dDowngraded one level as a result of inconsistency in and lack of reporting of adverse events.  ^eDowngraded one level as a result of imprecision: reported by only one small study of 48 participants.