Risks for Recurrence After Pediatric Primary Spontaneous Pneumothorax: Results From a Multicenter Study

Management of pediatric primary spontaneous pneumothorax (PSP) has practice variations and different risk factors for recurrence. Management of pediatric PSP is not standardized. The risk of recurrence may vary based on initial treatment strategy.

A multicenter retrospective review of patients (≤21 y) presented with PSP between 2011 and 2022. Initial management was categorized as observation, tube thoracostomy, or operation during the index admission. Chi-square, Fisher's exact, and Kruskal-Wallis tests were used to examine associations between patient characteristics at first PSP presentation and recurrence. Kaplan-Meier curves and multivariate Cox regression estimated the risk of ipsilateral PSP recurrence up to 5 y after primary hospitalization.

Of the 357 patients with PSP, most were male (88%) and White (75%). Median initial pneumothorax size was 4.5 cm. Management included observation in 72 (25.5%) patients, tube thoracostomy in 113 (40.1%) patients, and operative management in 91 (34.4%) patients. A total of 115 (32%) patients experienced ipsilateral recurrence at a median of 71 d (interquartile range: 20, 241) and 80% within 12 mo. Ipsilateral recurrence differed depending on initial management strategy, with 32% patients recurring after observation, 53% after tube thoracostomy, and 17% after operative management (P < 0.001). When compared to chest tube alone, observation of PSP was associated with decreased risk of recurrence (hazard ratio: 0.54; 95% confidence interval: 0.34-0.87, P = 0.011) and even further with surgery (hazard ratio: 0.22; 95% confidence interval: 0.12-0.39, P < 0.001).

Both observation and surgery have significantly lower recurrence rates than chest tube alone in managing pediatric PSP. The authors recommend against using chest tubes as the definitive management of PSP.