Management Patterns and Outcomes of Children With Traumatic Occult Pneumothorax.

Area of Science:

• Trauma Surgery
• Pediatric Critical Care
• Diagnostic Imaging

Background:

• Occult pneumothorax (oPTX) is a condition where a pneumothorax is not visible on chest X-ray (CXR) but is detected on computed tomography (CT).
• There is a lack of standardized management protocols for oPTX in pediatric trauma cases.
• This study examines the clinical presentation, imaging use, interventions, and management of oPTX in children.

Purpose of the Study:

• To describe the current patterns of clinical presentation, imaging utilization, interventions, and management strategies for traumatic occult pneumothorax in pediatric patients.
• To evaluate the impact of follow-up imaging on patient outcomes in this population.

Main Methods:

• A retrospective review was conducted at a Level 1 Pediatric Trauma Center from 2010 to 2023.
• Included were pediatric patients (≤18 years) with traumatic oPTX, defined as pneumothorax on CT but not CXR.
• Data collected included demographics, injury details, imaging findings, interventions, and outcomes.

Main Results:

• 162 pediatric patients with oPTX were identified; most had blunt trauma.
• Patients receiving follow-up imaging had higher injury severity scores and more complications, but no improved outcomes.
• A significant portion of screening CXRs (40.5%) were deemed unnecessary and did not alter patient management.

Conclusions:

• Follow-up imaging in pediatric oPTX is often driven by injury severity and complications, not necessarily by improved outcomes.
• Most screening imaging did not impact the clinical course, suggesting potential for selective use.
• Asymptomatic pediatric patients with lower injury scores may be safely observed without routine follow-up imaging.