Primary spontaneous pneumothorax in children: factors predicting recurrence and contralateral occurrence
Glenn Yang Han Ng1,2, Shireen Anne Nah3,4, Oon Hoe Teoh1,5,6
1Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
Insights
Surgery for a child's first primary spontaneous pneumothorax (PSP) may increase the risk of recurrence on the opposite side. Computerised tomography (CT) scans are not effective in predicting future PSP episodes.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Diagnostic Imaging
Background:
- Recurrence risk factors for primary spontaneous pneumothorax (PSP) in children are not well-established.
- Computerised tomography (CT) scans' utility in predicting pediatric PSP recurrence requires further investigation.
Purpose of the Study:
- To identify risk factors for PSP recurrence in pediatric patients.
- To assess the effectiveness of CT scans in predicting future PSP episodes in children.
Main Methods:
- Retrospective review of pediatric patients (<18 years) treated for PSP between 2008-2017.
- Exclusion of patients with malignancies; data collection included demographics, pneumothorax laterality, CT findings, treatments, and recurrence events.
- Multivariate logistic regression analysis to identify predictors of recurrence.
Main Results:
- Surgery during the first PSP episode was a significant predictor of contralateral recurrence (OR 32.026, p=0.021).
- No predictors for ipsilateral recurrence were identified.
- CT scans showed 76.5% sensitivity for bleb detection but had poor predictive value for PSP occurrence (PPV 14.3%).
Conclusions:
- First-episode surgery in children may predict contralateral PSP recurrence, a novel finding.
- CT scans demonstrate limited effectiveness in detecting blebs and predicting PSP recurrence in pediatric cases.
Background:
The risk factors for recurrence in primary spontaneous pneumothorax (PSP) in children are not well known. We aimed to identify possible risk factors, and to evaluate the utility of computerised tomography (CT) scans in predicting future episodes.
Methods:
We reviewed children aged < 18 years admitted to our institution for PSP from 2008 to 2017, excluding those with malignancies. Basic demographic data were extracted. Clinical data collected include pneumothorax laterality, CT results, treatment protocols and recurrences.
Results:
63 patients were included, 19 (30.2%) of whom had CT scans. A total of 41 surgeries were performed. The median (interquartile range) age was 15.4 years (14.9-15.9), and body-mass index was 17.9 kg/m2 (15.8-19.3). 56 (88.9%) patients were male. Median follow-up duration was 19.8 months (11.6-35.9). Multivariate logistic regression analyses identified surgery in the first episode as a predictor for a subsequent contralateral occurrence (odds ratio [95% confidence interval] 32.026 [1.685-608.518], p = 0.021). No predictors for ipsilateral recurrence were found. CT scans were 76.5% sensitive for bleb detection, and predicted poorly for occurrence (positive predictive value 14.3%, likelihood ratio 1.1).
Conclusion:
This is the first study demonstrating that surgery at first presentation appears to predict for occurrence of PSP on the contralateral lung. CT appears to be ineffective in detecting blebs and predicting PSP occurrence.
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