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Published on: March 12, 2020
Risks for Recurrence After Pediatric Primary Spontaneous Pneumothorax: Results From a Multicenter Study
Abigail J Engwall-Gill1, Katrina Morgan2, Jennine H Weller3
1Division of Pediatric Surgery, Department of Surgery, University of Michigan C. S. Mott Children's Hospital, Ann Arbor, Michigan.
The Journal of Surgical Research
|May 21, 2026
Summary
Observation or surgery significantly reduces recurrence of pediatric primary spontaneous pneumothorax (PSP) compared to chest tubes alone. Chest tubes are not recommended for definitive PSP management.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Clinical Outcomes Research
Background:
- Pediatric primary spontaneous pneumothorax (PSP) management lacks standardization.
- Recurrence risk factors and initial treatment strategies for pediatric PSP vary.
- The optimal initial management strategy for pediatric PSP requires further investigation.
Purpose of the Study:
- To evaluate the recurrence rates of pediatric primary spontaneous pneumothorax (PSP) based on initial management strategies.
- To compare the effectiveness of observation, tube thoracostomy, and operative management in preventing PSP recurrence.
- To identify the optimal treatment approach for minimizing recurrence in pediatric PSP patients.
Main Methods:
- Multicenter retrospective review of patients (≤21 years) with PSP from 2011-2022.
- Categorization of initial management into observation, tube thoracostomy, or operation.
- Statistical analysis including Chi-square, Fisher's exact, Kruskal-Wallis tests, Kaplan-Meier curves, and multivariate Cox regression to assess recurrence risk.
Main Results:
- 357 pediatric PSP patients analyzed; 32% experienced ipsilateral recurrence.
- Recurrence rates varied significantly by initial management: observation (32%), tube thoracostomy (53%), and operative management (17%).
- Observation (HR: 0.54) and surgery (HR: 0.22) showed significantly lower recurrence risks than chest tube alone.
Conclusions:
- Observation and surgical intervention are associated with significantly lower recurrence rates than chest tube management for pediatric PSP.
- Chest tube placement should not be considered the definitive management for pediatric PSP.
- The findings support a shift towards observation or surgical options for initial pediatric PSP management to reduce recurrence.
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