Effectiveness of intercostal tube drainage versus other invasive approaches in initial management of pneumothorax in adults: a systematic review and meta-analysis

BACKGROUND:
The comparative effectiveness of intercostal tube drainage (ITD) and less invasive methods in initial pneumothorax management remains uncertain.


OBJECTIVES:
To compare ITD with other invasive approaches in adults.


DESIGN:
A systematic review and meta-analysis based on PRISMA guidelines, covering twelve studies from nine countries (Iran, UK, Netherlands, USA, Belgium, Kuwait, Norway, Pakistan, Switzerland) published between 1994 and 2021.


MATERIALS AND METHODS:
A comprehensive search was conducted in PubMed, and Google Scholar. The study encompassed randomized controlled trials (RCTs), prospective and retrospective analyses with adults presenting pneumothorax. Quality assessment was conducted using the Cochrane risk-of-bias (RoB 2) tool for randomized trials and the MINORS tool for non-randomized studies.


MAIN OUTCOME MEASURES:
Immediate success rates, hospital stay durations, complication rates, and recurrence rates at 12 months.


SAMPLE SIZE:
A total of 1204 patients were included across 12 studies, ten RCTs (n=932), one prospective (n=60) and one retrospective study (n=212).


RESULTS:

Meta-analysis showed no statistically significant differences between the ITD and the less invasive techniques in the immediate success rate (OR: 0.88, 95% CI: 0.47-1.65,
P
=.69). Also, no difference was noticed in the 1-week success rate (OR: 1.01, 95% CI: 0.6-1.5,
P
=.96) and recurrence (OR: 1.20, 95% CI: 0.80-1.80,
P
=.38).



RISK OF BIAS:
The RoB was low in 82% of studies assessed by RoB 2 and the study evaluated by MINORS demonstrated a moderate RoB.


HETEROGENEITY:

A high statistical heterogeneity was observed (I
2
=77%).



CONCLUSIONS:
ITD and other invasive approaches demonstrated comparable effectiveness, with no significant differences in immediate success, 1-week success, or recurrence rates.


LIMITATIONS:
The studies varied widely in design, patient groups, and quality. There were also signs of publication bias and a limited number of high-quality RCTs.


PROSPERO REGISTRATION NUMBER:
CRD42024517888.