Management and recurrence of spontaneous pneumothorax in children
Martin Gariépy1, Mona Beaunoyer2, Marie-Claude Miron3
1Faculty of Medicine, Université Laval, Quebec City, Quebec.
Insights
Management of spontaneous pneumothorax in children varies, with chest tube insertion being common. Recurrence rates are significant, ranging from 37-52% in pediatric patients, often occurring within months.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Clinical Practice Guidelines
Background:
- Spontaneous pneumothorax in children lacks standardized management guidelines.
- Understanding practice variations and recurrence is crucial for pediatric care.
Purpose of the Study:
- To evaluate practice variations in managing spontaneous pneumothorax in children.
- To determine the probability of recurrence after a first episode.
Main Methods:
- Retrospective chart review of pediatric patients with first-time spontaneous pneumothorax (2008-2017).
- Phone follow-up to assess recurrence.
- Analysis of management strategies (observation, oxygen, needle aspiration, chest tube, surgery) and recurrence rates.
Main Results:
- 76 children were included; 59 with primary spontaneous pneumothorax, 17 secondary.
- Common initial treatments: chest tube (31), oxygen (27), observation (14).
- Recurrence observed in 28 of 54 follow-up patients (37-52% of cohort).
Conclusions:
- Chest tube insertion was the primary treatment for ~40% of pediatric spontaneous pneumothorax cases.
- Recurrence probability in children is between 37% and 52%.
- Most recurrences happen within months following the initial event.
Objective:
No guideline clearly prescribes an approach to management of spontaneous pneumothorax in children. The objectives of this study were to evaluate practice variation in the management of spontaneous pneumothorax in children and its probability of recurrence.
Methods:
This study was a retrospective chart review followed by a phone follow-up that included all children who had visited a tertiary care paediatric hospital for a first episode of spontaneous pneumothorax between 2008 and 2017. The primary outcomes were the management of pneumothorax (observation, oxygen, needle aspiration, intercostal chest tube, surgery) and the probability of recurrence. All charts were evaluated by a rater using a standardized report form and 10% of the charts were evaluated in duplicate. All children/families were contacted by phone to assess recurrence. The primary analyses were the proportions of each treatment modalities and recurrence, respectively.
Results:
During the study period, 76 children were deemed eligible for the study. Among them, 59 had a primary spontaneous pneumothorax while 17 were secondary. The most common first therapeutic approaches were chest tube insertion (31), oxygen alone (27), and observation (14). A total of 54 patients were available for follow-up among whom a recurrence was observed in 28 (37% of the total cohort or 52% of available children).
Conclusion:
Chest tube insertion was the first line of treatment in about 40% of children with a first spontaneous pneumothorax. In this population, the recurrence probability is established between 37 and 52% and the majority occurs in the following months.
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