Concrete filled steel hollow structural sections (CFSs) are an efficient, sustainable, and attractive option for both ambient temperature and fire resistance design of columns in multi-storey buildings and are becoming increasingly common in modern construction practice around the world. Whilst the design of these sections at ambient temperatures is reasonably well understood, and models to predict the strength and failure modes of these elements at ambient temperatures correlate well with observations from tests, this appears not to be true in the case of fire resistant design. This paper reviews available data from furnace tests on CFS columns and assesses the statistical confidence in available fire resistance design models/approaches used in North America and Europe. This is done using a meta-analysis comparing the available experimental data from large-scale standard fire tests performed around the world against fire resistance predictions from design codes. It is shown that available design approaches carry a very large uncertainty of prediction, suggesting that they fail to properly account for fundamental aspects of the underlying thermal response and/or structural mechanics during fire. Current North American fire resistance design approaches for CFS columns are shown to be considerably less conservative, on average, than those used in Europe.