Methods of measurement for pneumothorax in pediatric patients: a systematic review
Grant S Owen1, Kelly A Harmon1, Gwyneth A Sullivan2
1Rush Medical College, Rush University Medical Center, Chicago, IL, USA.
Insights
Accurate measurement of pneumothorax (PTX) size in children is crucial. The Collins method is currently preferred due to its accuracy, though pediatric-specific guidelines are needed for consistent clinical practice.
Area of Science:
- Pediatric Radiology
- Thoracic Imaging
- Clinical Decision Support
Background:
- Accurate measurement of pneumothorax (PTX) size is vital for clinical decision-making in pediatric patients.
- Current methods for measuring PTX size on chest X-rays (CXRs) lack a standardized consensus in pediatric care.
Purpose of the Study:
- To systematically review and evaluate methods used for measuring PTX size in pediatric patients via CXR.
- To identify existing measurement techniques and assess their application and comparison in the literature.
Main Methods:
- A systematic literature review adhering to PRISMA guidelines was performed.
- Databases searched included Ovid/MEDLINE, Scopus, Cochrane, and Google Scholar up to 2021.
- Included studies focused on pediatric patients (<18 years) and detailed PTX measurement methods.
Main Results:
- Forty-five studies were analyzed, categorizing methods (Kircher and Swartzel, Rhea, Light, Collins, Other) and guidelines.
- The Collins method was most frequently used (35.6%).
- Only 8.9% of studies compared validated methods, with all finding the Collins method accurate. Significant disagreement was noted between classification guidelines.
Conclusions:
- There is a need for pediatric-specific PTX measurement guidelines to ensure consistency in research and clinical practice.
- The Collins method is currently the preferred approach for PTX size measurement in pediatric patients.
- Further research is required to develop and validate standardized pediatric PTX measurement protocols.
Abstract:
Accurate measurement of pneumothorax (PTX) size is necessary to guide clinical decision making; however, there is no consensus as to which method should be used in pediatric patients. This systematic review seeks to identify and evaluate the methods used to measure PTX size with CXR in pediatric patients. A systematic review of the literature through 2021 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was conducted using the following databases: Ovid/MEDLINE, Scopus, Cochrane Database of Controlled Trials, Cochrane Database of Systematic Reviews, and Google Scholar. Original research articles that included pediatric patients (< 18 years old) and outlined the PTX measurement method were included. 45 studies were identified and grouped by method (Kircher and Swartzel, Rhea, Light, Collins, Other) and societal guideline used. The most used method was Collins (n = 16; 35.6%). Only four (8.9%) studies compared validated methods. All found the Collins method to be accurate. Seven (15.6%) studies used a standard classification guideline and 3 (6.7%) compared guidelines and found significant disagreement between them. Pediatric-specific measurement guidelines for PTX are needed to establish consistency and uniformity in both research and clinical practice. Until there is a better method, the Collins method is preferred.
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