Management of Spontaneous Pneumothorax in Children: A Systematic Review and Meta-Analysis
Maria Enrica Miscia1, Giuseppe Lauriti1, Gabriele Lisi1
1Department of Pediatric Surgery, "Spirito Santo" Hospital, Pescara, "G. d'Annunzio" University, Chieti-Pescara, Italy.
Insights
Surgical management of pediatric primary spontaneous pneumothorax (PSP) may lead to better outcomes than non-surgical approaches. This meta-analysis suggests surgery reduces recurrence rates in children with PSP.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Evidence-Based Medicine
Background:
- Management guidelines for primary spontaneous pneumothorax (PSP) are primarily based on adult data, with controversial recommendations for pediatric cases.
- Optimal treatment strategies for pediatric PSP remain unclear, necessitating further investigation into comparative outcomes.
Purpose of the Study:
- To compare length of hospital stay (LOS) among conservative, aspiration/chest drain, and surgical management for pediatric PSP.
- To evaluate the risk of PSP recurrence following non-surgical versus surgical treatment in children.
- To assess the impact of bullae presence on recurrence risk in pediatric PSP.
Main Methods:
- A systematic review and meta-analysis adhering to PRISMA guidelines was conducted.
- Studies were identified using a defined search strategy, with case reports and gray literature excluded.
- Data from 16 studies including 1,633 pediatric patients were quantitatively analyzed.
Main Results:
- Length of hospital stay was comparable between conservative and surgical management groups.
- Recurrence rates were significantly higher in children managed non-surgically (32%) compared to surgically (18%).
- Recurrence rates for aspiration/chest drain (34%) were slightly higher than conservative management (27%), with no significant difference based on bullae presence.
Conclusions:
- The study suggests that surgical intervention as a first-line management may offer better outcomes for pediatric PSP.
- Current evidence indicates a lower risk of recurrence with surgical treatment compared to non-surgical options in children.
- Standardized management protocols for pediatric PSP are lacking, highlighting the need for further research and clinical consensus.
Introduction:
Management of primary spontaneous pneumothorax (PSP) is mainly based on adults. Data are controversial with regards to its management in children. We aimed to assess: (1) the length of hospital stay (LOS) between conservative management (i.e., observation with O2 administration), aspiration/chest drain, and surgical management; (2) the risk of recurrence after nonsurgical treatment versus surgery; (3) the risk of recurrence in the presence of bullae.
Materials And Methods:
Using a defined search strategy, three independent investigators identified all the studies on the management of PSP in children. Case reports, opinion articles, and gray literature publications were excluded. The study was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A meta-analysis was performed using RevMan 5.3. Data are expressed as mean ± SD.
Results:
Of 3,089 abstracts screened, 95 full-text were analyzed, 23 were included in the quantitative analysis, and 16 were included in the meta-analysis (1,633 patients). LOS was similar between conservative and surgical management (6.2 ± 0.8 days vs. 5.9 ± 1.4 days; p = ns). Recurrence of PSP was significantly higher among children with a nonsurgical management (32%) versus those surgically treated (18%; p = 0.002). The incidence of recurrence was slightly higher in patients managed by aspiration/chest drain (34%) compared with those with a conservative management (27%; p = 0.05). Risk of recurrence in patients with or without documented bullae was not significantly different (26 vs. 38%, respectively; p = ns).
Conclusion:
Given the lack of a standardized management of pediatric PSP, the present study seems to demonstrate a better outcome in children treated with surgery as first-line of management.
Level Of Evidence:
This is a Level III study.
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