Large simple pneumothorax? Consider conservative treatment

When faced with a spontaneous simple pneumothorax, in a previously well child the Archivist would probably leave the smallest of air leaks alone (in a child with no symptoms) and follow-up conservatively. Some sort of intervention is usually advised for the bigger pneumothoraces and written guidelines, often extrapolated from adult evidence, recommend drainage. A large Australian paediatric case series by Robinson et al (https://ift.tt/39vSWnm) showed most children had an intervention. Can the adult literature help us? Brown SGA et al(N Engl J Med 2020; 382:405–415 DOI: 10.1056/NEJMoa191077) have published, also from Australia, the results of a randomised controlled study of conservative treatment versus intervention in larger pneumothoraces (primary spontaneous pneumothorax of 32% or more on chest radiography according to the Collins method (sum of interpleural distances, >6 cm)). It is an adult study but included a study cohort aged 14 and above. I think it is worthwhile examining. It...

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