Management of spontaneous pneumomediastinum in children
John W Fitzwater1, Naomi N Silva2, Colin G Knight1
1Department of Surgery, Miami Children's Hospital, Miami, FL, USA.
Insights
Pediatric spontaneous pneumomediastinum is often manageable with outpatient observation. Asthma management should be independent of pneumomediastinum, as it does not impact outcomes.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Medical Diagnostics
Background:
- Spontaneous pneumomediastinum (SPM) is a rare condition characterized by air in the mediastinum.
- Optimal management strategies for pediatric SPM require further elucidation.
Purpose of the Study:
- To characterize outcomes of pediatric SPM in the largest series to date.
- To propose a management pathway for pediatric SPM.
Main Methods:
- Retrospective review of pediatric patients diagnosed with isolated SPM (ICD-9 code 518.1) between 2003 and 2014.
- Analysis of admission data, intensive care unit (ICU) stay, complications, and patient outcomes.
Main Results:
- Ninety-six children experienced 99 episodes of SPM; median age was 14.1 years.
- Most patients were hospitalized, with 20.2% requiring ICU admission; median length of stay was 1 day (non-ICU) and 3 days (ICU).
- No SPM-related complications occurred; follow-up imaging did not alter management, and recurrences were rare and uneventful.
Conclusions:
- Pediatric SPM without comorbidities can be managed with expectant outpatient observation and no further imaging.
- Asthma in pediatric patients should be managed independently of SPM, as it does not influence SPM outcomes or management.
Purpose:
We characterize the outcomes of pediatric spontaneous pneumomediastinum in the largest series to date and propose a management pathway.
Methods:
All patients at our institution with ICD-9 code 518.1 confirmed to have isolated radiographic findings of spontaneous pneumomediastinum between January 2003 and February 2014 were retrospectively reviewed for admission, intensive care unit (ICU) stay, complications, and outcome.
Results:
We identified 96 children with 99 episodes, median age 14.1 years (IQR: 8.7-16.4). Primary symptoms were chest pain, cough, and dyspnea. Most were hospitalized (n=91, 91.9%), with 20 (20.2%) admitted to ICU. Median lengths of stay (LOS) were 1 day (IQR: 1-2) for non-ICU admissions and 3 days (IQR: 2-3) for ICU admissions. The surgical service discharged non-ICU patients 0.94 days earlier than medical services (95% CI 0.38-1.50, p=0.0014). Asthma affected neither LOS nor ICU admission rates. Follow-up imaging, when obtained (n=81, 81.8%), did not alter management. Recurrences occurred in three asthmatics, all after one year. Each was rehospitalized and discharged uneventfully. No patient developed pneumomediastinum-related complications (e.g., pneumothorax, pneumopericardium, or mediastinitis).
Conclusion:
Spontaneous pneumomediastinum without associated comorbidities can be managed with expectant outpatient observation without further imaging. Children with asthma should be treated independent of spontaneous pneumomediastinum.
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