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Management of paediatric spontaneous pneumothorax: a multicentre retrospective case series
  1. Paul D Robinson1,2,
  2. Carol Blackburn3,
  3. Franz E Babl3,
  4. Lalith Gamage4,
  5. Jacquie Schutz4,
  6. Rebecca Nogajski5,
  7. Stuart Dalziel6,7,
  8. Colin B Donald6,
  9. Dino Druda8,
  10. David Krieser8,
  11. Jocelyn Neutze9,
  12. Jason Acworth10,
  13. Mark Lee11,
  14. Peter K Ngo1
  15. on behalf of the Paediatric Emergency Departments International Collaborative (PREDICT) research network
    1. 1Department of Respiratory Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
    2. 2Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia
    3. 3Royal Children's Hospital, Murdoch Children's Research Institute and University of Melbourne, Melbourne, Australia
    4. 4Emergency Department, Children, Youth and Women's Health Service, Adelaide, Australia
    5. 5Emergency Department, Sydney Children's Hospital, Sydney, Australia
    6. 6Starship Hospital, Auckland, New Zealand
    7. 7Liggins Institute, University of Auckland, New Zealand
    8. 8Emergency Medicine Department, Sunshine Hospital, St Albans, Victoria, Australia
    9. 9Emergency Medicine Department, Kidzfirst Middlemore Hospital, Otahuhu, New Zealand
    10. 10Emergency Medicine Department, Royal Children's Hospital, Brisbane, Australia
    11. 11Emergency Medicine Department, John Hunter Hospital, Newcastle, New South Wales, Australia
    1. Correspondence to Dr Paul D Robinson, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia; paul.robinson1{at}health.nsw.gov.au

    Abstract

    Objectives Paediatric guidelines are lacking for management of spontaneous pneumothorax. Adult patient-focused guidelines (British Thoracic Society 2003 and 2010) introduced aspiration as first-line intervention for primary spontaneous pneumothorax (PSP) and small secondary spontaneous pneumothoraces (SSP). Paediatric practice is unclear, and evidence for aspiration success rates is urgently required to develop paediatric-specific recommendations.

    Methods Retrospective analysis of PSP and SSP management at nine paediatric emergency departments across Australia and New Zealand (2003–2010) to compare PSP and SSP management.

    Results 219 episodes of spontaneous pneumothorax occurred in 162 children (median age 15 years, 71% male); 155 PSP episodes in 120 children and 64 SSP episodes in 42 children. Intervention in PSP vs SSP episodes occurred in 55% (95% CI 47% to 62%) vs 70% (60% to 79%), p<0.05. An intercostal chest catheter (ICC) was used in 104/219 (47%) episodes. Aspiration was used in more PSP than in SSP episodes with interventions (27% (18% to 37%) vs 9% (3% to 21%), p<0.05). Aspiration success was 52% (33% to 70%) overall and not significantly different between PSP and SSP. Aspiration success was greater in small vs large pneumothoraces (80% (48% to 95%) vs 33% (14% to 61%), p=0.01). Small-bore ICCs were used in 40% of ICCs and usage increased during the study.

    Conclusions In this descriptive study of pneumothorax management, PSP and SSP management did not differ and ICC insertion was the continuing preferred intervention. Overall success of aspiration was lower than reported results for adults, although success was greater for small than for large pneumothoraces. Paediatric prospective studies are urgently required to determine optimal paediatric interventional management strategies.

    • Paediatric Practice
    • Respiratory
    • Accident & Emergency

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