Presenter Status
Fellow
Abstract Type
Clinical Research
Primary Mentor or Principal Investigator
Shawn St. Peter
Presentation Type
Oral Presentation
Start Date
15-5-2026 12:30 PM
End Date
15-5-2026 12:45 PM
Abstract Text
INTRODUCTION: The treatment of primary spontaneous pneumothorax (PSP) varies greatly across institutions with our institution previously performing simple aspiration with a 12-Thal chest tube, a 6-hour clamp trial and repeat imaging. Presence of a pneumothorax or air leak after clamp release defined failure and admission for operative management. A modified protocol involving initial management of observation with repeat imaging followed by admission with chest tube placement and subsequent VATS in the case of worsening pneumothorax was instituted. This describes the outcomes of PSP management using early observation alone.
METHODS: A single institution prospective analysis was conducted at a tertiary children’s hospital on patients diagnosed with PSP on radiographic imaging between July 2023 and May 2025. Stable patients were initially managed with observation alone followed by repeat chest X-ray at four hours. Patients with stable or improved imaging were discharged with follow up and those who worsened were admitted after chest tube placement and underwent early VATS. Results were reviewed and compared against prior outcomes when aspiration was the management technique of choice.
RESULTS: Eighteen patients were included in the study with a median age of 16.1 yrs. All patients were treated with observation alone initially, with 15 patients remaining stable on imaging with subsequent discharge. The 3 additional patients had chest tube placement and VATS with median LOS of 3.8 days. None of the 15 discharged patients had a 30-day return visit secondary to pneumothorax related issues and 11 had documented follow up with resolution of symptoms. When compared to our prior results of aspiration, we show a significant reduction in need for operative intervention and a reduction of LOS for those managed in the Emergency Department with conservation measures.
Table 1: Comparison of Aspiration versus Observation for Spontaneous Pneumothorax
Aspiration
Observation
p-value
N
59
18
Non-operative technique success
20 (33%)
15 (83.3%)
< 0.05
LOS Non-operative Median (Days)
0.85
0.19
< 0.05
LOS Operative Median (Days)
3.1
3.8
0.38
CONCLUSION: Observation alone is safe and effective for the initial management of PSP in pediatric patients and significantly reduced the need for operative intervention when compared to aspiration.
Evaluation of a Pilot Study for Observation in Primary Spontaneous Pneumothorax in Pediatric Patients
INTRODUCTION: The treatment of primary spontaneous pneumothorax (PSP) varies greatly across institutions with our institution previously performing simple aspiration with a 12-Thal chest tube, a 6-hour clamp trial and repeat imaging. Presence of a pneumothorax or air leak after clamp release defined failure and admission for operative management. A modified protocol involving initial management of observation with repeat imaging followed by admission with chest tube placement and subsequent VATS in the case of worsening pneumothorax was instituted. This describes the outcomes of PSP management using early observation alone.
METHODS: A single institution prospective analysis was conducted at a tertiary children’s hospital on patients diagnosed with PSP on radiographic imaging between July 2023 and May 2025. Stable patients were initially managed with observation alone followed by repeat chest X-ray at four hours. Patients with stable or improved imaging were discharged with follow up and those who worsened were admitted after chest tube placement and underwent early VATS. Results were reviewed and compared against prior outcomes when aspiration was the management technique of choice.
RESULTS: Eighteen patients were included in the study with a median age of 16.1 yrs. All patients were treated with observation alone initially, with 15 patients remaining stable on imaging with subsequent discharge. The 3 additional patients had chest tube placement and VATS with median LOS of 3.8 days. None of the 15 discharged patients had a 30-day return visit secondary to pneumothorax related issues and 11 had documented follow up with resolution of symptoms. When compared to our prior results of aspiration, we show a significant reduction in need for operative intervention and a reduction of LOS for those managed in the Emergency Department with conservation measures.
Table 1: Comparison of Aspiration versus Observation for Spontaneous Pneumothorax
Aspiration
Observation
p-value
N
59
18
Non-operative technique success
20 (33%)
15 (83.3%)
< 0.05
LOS Non-operative Median (Days)
0.85
0.19
< 0.05
LOS Operative Median (Days)
3.1
3.8
0.38
CONCLUSION: Observation alone is safe and effective for the initial management of PSP in pediatric patients and significantly reduced the need for operative intervention when compared to aspiration.
