International ground-breaking study to change medical practice

Dr Diana Egerton-Warburton

In a world-first clinical trial supported by an NHMRC grant, the management of a common disease affecting young people is being investigated at Monash Health and Monash University.

Primary spontaneous pneumothorax (PSP), or collapsed lung, is a significant global health problem and the most common disease of its type affecting adolescents and young adults.  

At present, management of the condition is variable due to a lack of evidence guiding emergency doctors.

“Current guidelines emphasise the importance of intervention, which involves insertion of a chest drain, hospital admission, and sometimes thoracic surgery,” said Primary Investigator Dr Diana Egerton-Warburton, Director of Emergency Medicine Research at Monash Medical Centre and Adjunct Senior Lecturer at the School of Clinical Sciences.

“However, this approach has recently been questioned and there is evidence to suggest that conservative management without intervention is effective and safe.”

Conservative management involves monitoring patient pain, breathlessness and vital signs.  Patients are discharged from hospital if they are comfortable and their vital signs are stable, and then reviewed regularly until the lung reinflates and the condition resolves.

Although still underway, initial study data indicates that while conservative management takes longer for PSP to resolve, interventional management leads to longer hospital admission periods, more surgical procedures and recurrences.

“This is the largest randomised controlled trial investigating initial management of PSP and will have a global impact whatever the findings, providing the first high level evidence for how to treat PSP,” said Chief Investigator and Surgical Lead, Professor Julian Smith, Head, Department of Surgery at the School of Clinical Sciences and Head, Department of Cardiothoracic Surgery at Monash Medical Centre.

“If conservative management is demonstrated to be safe and effective it will lead to a major change in current medical practice and have an international impact,” added Professor Smith.

“It has the potential to reduce morbidity and deliver economic benefits through reductions in procedures, complications and hospital admissions.”

The international collaborative research project includes emergency, cardiothoracic and respiratory physicians in 38 hospitals in Australia and New Zealand.

“Monash Health is playing a significant role in the study as the second largest recruiting site,” added Dr Egerton-Warburton. “Monash Health has three Emergency Departments: Monash Medical Centre, Dandenong and Casey hospitals, and across these sites we see almost one-third of all emergency patients in Melbourne.”

This pioneering study may be a classic example of when left alone, the body heals itself quite effectively.