Management of Primary Spontaneous Pneumothorax in Children: A Single Institution Protocol Analysis.

Creator(s)

Shai Stewart MD, Children's Mercy HospitalFollow
James Fraser, Children's Mercy HospitalFollow
Rebecca M. Rentea, Children's Mercy HospitalFollow
Pablo Aguayo, Children's Mercy HospitalFollow
David Juang, Children's Mercy HospitalFollow
Jason D. Fraser, Children's Mercy HospitalFollow
Charles L. Snyder, Children's Mercy HospitalFollow
Richard J. Hendrickson, Children's Mercy HospitalFollow
Tolulope A. Oyetunji MD MPH, Children's Mercy Kansas CityFollow
Shawn D. St Peter, Children's Mercy HospitalFollow

Document Type

Article

Publication Date

8-2023

Identifier

DOI: 10.1016/j.jpedsurg.2022.12.034

Abstract

BACKGROUND: The Midwest Pediatric Surgery Consortium (MWPSC) suggested a simple aspiration of primary spontaneous pneumothorax (PSP) protocol, failing which, Video-Assisted Thoracoscopic Surgery (VATS) should be considered. We describe our outcomes using this suggested protocol.

METHODS: A single institution retrospective analysis was conducted on patients between 12 and 18 years who were diagnosed with PSP from 2016 to 2021. Initial management involved aspiration alone with a ≤12 F percutaneous thoracostomy tube followed by clamping of the tube and chest radiograph at 6 h. Success was defined as ≤2 cm distance between chest wall and lung at the apex and no air leak when the clamp was released. VATS followed if aspiration failed.

RESULTS: Fifty-nine patients were included. Median age was 16.8 years (IQR 15.9, 17.3). Aspiration was successful in 33% (20), while 66% (39) required VATS. The median LOS with successful aspiration was 20.4 h (IQR 16.8, 34.8), while median LOS after VATS was 3.1 days (IQR 2.6, 4). In comparison, in the MWPSC study, the mean LOS for those managed with a chest tube after failed aspiration was 6.0 days (±5.5). Recurrence after successful aspiration was 45% (n = 9), while recurrence after VATS was 25% (n = 10). Median time to recurrence after successful aspiration was sooner than that of the VATS group [16.6 days (IQR 5.4, 19.2) vs. 389.5 days (IQR 94.1, 907.0) p = 0.01].

CONCLUSION: Simple aspiration is safe and effective initial management for children with PSP, although most will require VATS. However, early VATS reduces length of stay and morbidity.

LEVEL OF EVIDENCE: IV. Retrospective study.

Journal Title

Journal of pediatric surgery

Volume

58

Issue

8

First Page

1446

Last Page

1449

MeSH Keywords

Humans; Child; Adolescent; Pneumothorax; Retrospective Studies; Recurrence; Chest Tubes; Thoracotomy; Thoracic Surgery, Video-Assisted; Treatment Outcome

Keywords

Pediatric; Spontaneous pneumothorax; Thoracoscopic surgery

Recommended Citation

Stewart S, Fraser JA, Rentea RM, et al. Management of Primary Spontaneous Pneumothorax in Children: A Single Institution Protocol Analysis. J Pediatr Surg. 2023;58(8):1446-1449. doi:10.1016/j.jpedsurg.2022.12.034