Aims No specific guidelines for the management of spontaneous pneumothorax in the paediatric population have been published. Adult guidelines are frequently observed but these are not always applicable in children. We aimed to assess the management of spontaneous pneumothorax in our paediatric tertiary referral centre against guidance set out by the British Thoracic Society (BTS) with the long term goal of producing a set of paediatric specific guidelines for the management of spontaneous pneumothorax.

Methods Retrospective case note analysis of all patients under 16 years of age presenting to our centre with a diagnosis of pneumothorax during the period between January 2014 and May 2015 was performed. Patients with an identifiable cause for their pneumothorax were excluded. Subsequent patient management was assessed against BTS guidelines. The primary outcome measure was mode of management; conservative, needle thoracocentesis, tube thoracostomy or surgical management. The secondary outcome measure was pneumothorax recurrence rate.

Results 28 patients with 32 episodes of pneumothorax were included in the study. A total of 62.5% of episodes were managed in line with adult BTS guidelines. Where deviation from guidelines occurred, the commonest reasons were escalation of treatment straight to tube thoracostomy without attempting needle thoracocentesis, or in complicated cases attempting needle thoracocentesis prior to tube thoracostomy. 2 patients underwent video-assisted thoracoscopic surgery (VATS) for bilateral recurrent pneumothoraces. 8 patients underwent needle thoracocentesis and in all 8 a chest drain was subsequently placed. Of those episodes where adult guidelines were followed, 85% were managed successfully as defined by resolution of the pneumothorax.

Conclusions Despite the overall high rate of success of spontaneous pneumothorax management with the use of adult BTS guidelines, this study has shown that needle thoracocentesis is an ineffective management strategy in these paediatric cases, since all patients who underwent needle thoracocentesis required further intervention in the form of tube thoracostomy. We recommend a prospective study to confirm these findings followed by production of paediatric specific guidelines.