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Hung CS, Chen YC, Yang TF, Huang FH. Systematic review and meta-analysis on juvenile primary spontaneous pneumothorax: Conservative or surgical approach first? PLoS One 2021; 16:e0250929. [PMID: 33930078 PMCID: PMC8087103 DOI: 10.1371/journal.pone.0250929] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/18/2021] [Indexed: 11/18/2022] Open
Abstract
Background Primary spontaneous pneumothorax (PSP) prevalence is typically higher in juvenile patients than in adults. We aimed to evaluate the optimal treatment for primary spontaneous pneumothorax and its efficacy and safety in juveniles. Materials and methods We searched PubMed, Embase, and Cochrane databases for eligible studies published from database inception to October 10, 2020, and conducted a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary and secondary outcomes were recurrence rate and hospital stay length, respectively. Odds ratios (OR) and mean differences were used for quantitatively analyzing binary and continuous outcomes, respectively. In total, nine retrospective studies with 1,452 juvenile patients (aged <21) were included for the quantitative analysis. The surgical approach led to a lower recurrence rate than did conservative approaches (OR: 1.95, 95% confidence interval: 1.15–3.32). Moreover, the recurrence rate was low in patients who underwent conservative treatment first and received surgery later. Conclusions Surgical approach for first-line management might have a greater effect on recurrence prevention than do conservative approaches. An upfront surgery might be an optimal choice for juvenile primary spontaneous pneumothorax.
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Affiliation(s)
- Chun-Shan Hung
- Department of Medical Education, Changhua Christian Hospital, Changhua City, Taiwan
| | - Yang-Ching Chen
- Department of Family Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
- Department of Family Medicine, School of medicine, College of medicine, Taipei Medical University, Taipei City, Taiwan
| | - Ten-Fang Yang
- Department of Biological Science and Technology, National Chiao-Tung University, Hsinchu City, Taiwan
- Graduate Institute of Biomedical Informatics, Taipei Medical University and Hospital, Taipei City, Taiwan
| | - Fu-Huan Huang
- Department of Biological Science and Technology, National Chiao-Tung University, Hsinchu City, Taiwan
- Division of Pediatric Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei City, Taiwan
- * E-mail:
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Lin CH, Lin CL, Lin WC, Wei CC. Long-term risk of pneumothorax in asthmatic children: A 12-year population-based cohort study. Medicine (Baltimore) 2020; 99:e23779. [PMID: 33371147 PMCID: PMC7748327 DOI: 10.1097/md.0000000000023779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/16/2020] [Indexed: 11/26/2022] Open
Abstract
Pneumothorax is a life-threatening complication during acute asthma attack. However, long-term risk of pneumothorax in asthmatic children remains unknown.In this retrospective cohort study, 333,657 children were defined as asthma cohort and a 1:1 matched non-asthma cohort were generated from 2000 to 2011. At the end of 2012, the incidence of pneumothorax in asthma and non-asthma cohorts and asthma to non-asthma hazard ratios (HRs) with confidence intervals (CIs) of pneumothorax were analyzed.The incidence of pneumothorax was 1.35-fold higher in the asthma cohort than that in the non-asthma cohort. The asthma to non-asthma HRs of pneumothorax were higher in children younger than 6 years (1.76, 95% CI: 1.21-2.57) and in girls (2.27; 95% CI: 1.23-4.16). The HRs of pneumothorax were higher in asthmatic children with more asthma-related out-patient clinic visits/per year (>5 visits; HR: 2.81; 95% CI: 1.79-4.42), more emergency department visits/per year (>4 visits; HR: 1.68; 95% CI: 1.02-2.78), and longer hospitalization days due to asthma (>4 days; HR: 3.42; 95% CI: 1.52-6.94) (P < .0001, the trend test).Asthmatic children had greater risk for pneumothorax, particularly in young children and in those with severe and uncontrolled asthma.
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Affiliation(s)
- Chien-Heng Lin
- Children's Hospital, China Medical University Hospital
- Department of Biomedical Imaging and Radiological Science, China Medical University
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital
- School of Medicine, China Medical University
| | - Wei-Ching Lin
- School of Medicine, China Medical University
- Department of Radiology, China Medical University Hospital
| | - Chang-Ching Wei
- Children's Hospital, China Medical University Hospital
- School of Medicine, China Medical University, Taichung, Taiwan
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Robinson PD, Blackburn C, Babl FE, Gamage L, Schutz J, Nogajski R, Dalziel S, Donald CB, Druda D, Krieser D, Neutze J, Acworth J, Lee M, Ngo PK. Management of paediatric spontaneous pneumothorax: a multicentre retrospective case series. Arch Dis Child 2015; 100:918-23. [PMID: 25670402 DOI: 10.1136/archdischild-2014-306696] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 01/19/2015] [Indexed: 11/03/2022]
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.
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Affiliation(s)
- Paul D Robinson
- Department of Respiratory Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia
| | - Carol Blackburn
- Royal Children's Hospital, Murdoch Children's Research Institute and University of Melbourne, Melbourne, Australia
| | - Franz E Babl
- Royal Children's Hospital, Murdoch Children's Research Institute and University of Melbourne, Melbourne, Australia
| | - Lalith Gamage
- Emergency Department, Children, Youth and Women's Health Service, Adelaide, Australia
| | - Jacquie Schutz
- Emergency Department, Children, Youth and Women's Health Service, Adelaide, Australia
| | - Rebecca Nogajski
- Emergency Department, Sydney Children's Hospital, Sydney, Australia
| | - Stuart Dalziel
- Starship Hospital, Auckland, New Zealand Liggins Institute, University of Auckland, New Zealand
| | | | - Dino Druda
- Emergency Medicine Department, Sunshine Hospital, St Albans, Victoria, Australia
| | - David Krieser
- Emergency Medicine Department, Sunshine Hospital, St Albans, Victoria, Australia
| | - Jocelyn Neutze
- Emergency Medicine Department, Kidzfirst Middlemore Hospital, Otahuhu, New Zealand
| | - Jason Acworth
- Emergency Medicine Department, Royal Children's Hospital, Brisbane, Australia
| | - Mark Lee
- Emergency Medicine Department, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Peter K Ngo
- Department of Respiratory Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Boudreau B, Nelson LL, Carey SA, Williams KJ. Spontaneous pneumothorax secondary to reactive bronchopneumopathy in a dog. J Am Vet Med Assoc 2013; 242:658-62. [PMID: 23402413 DOI: 10.2460/javma.242.5.658] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION An 8-year-old 38-kg (84-lb) castrated male German Shepherd Dog cross was evaluated because of respiratory distress secondary to pneumothorax (detected radio-graphically prior to referral). CLINICAL FINDINGS CT of the thorax confirmed the presence of pneumothorax and revealed pulmonary blebs without evidence of infiltrative pulmonary changes. A tentative diagnosis of primary spontaneous pneumothorax was made. TREATMENT AND OUTCOME Exploratory median sternotomy revealed emphysematous changes along the margins of all lung lobes, with the ventral margins of the left cranial, right cranial, and right middle lung lobes most affected. Partial lobectomies of the ventral aspects of these lobes were performed. Histologic examination of tissue samples from the lung lobes revealed diffuse smooth muscle hypertrophy of the terminal and respiratory bronchioles with moderate numbers of peribronchiolar eosinophils. Mucus plugs and mucous cell metaplasia within the airway epithelium were also evident. After surgery, clinical signs resolved and the dog was discharged from the hospital 2 days later. Eight months after surgery, the dog developed a mild cough, and treatment with prednisolone (tapering dosage starting at 0.5 mg/kg [0.023 mg/lb], PO, q 12 h) was initiated. Dosage reduction resulted in recurrence of coughing; however, with continued prednisolone treatment at a dosage of 0.5 mg/kg, PO, once daily, the dog was not coughing at 10 months after surgery. CLINICAL RELEVANCE Reactive bronchopneumopathy should be included as a differential diagnosis for spontaneous pneumothorax in dogs.
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Affiliation(s)
- Bianca Boudreau
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
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Abstract
Spontaneous pneumothorax (SP) occurs when air enters the pleural space in the absence of a traumatic or iatrogenic etiology and is an uncommon phenomenon in the pediatric population. Although the typical presentation has been well described in the literature, much debate still surrounds the epidemiology, pathophysiology, diagnosis, and management of this condition in the pediatric population. To date, much of the emphasis in the pediatric literature has been on surgical options. Questions still remain regarding the true incidence of this disease in children, appropriate diagnostic imaging, and treatment recommendations for practitioners in the emergency department setting. This review of the evidence seeks to elaborate on current knowledge and clinical practice, as well as the applicability of adult recommendations to the pediatric population.
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Abstract
OBJECTIVES Research on spontaneous pneumothorax (SP) has focused on management strategies in adolescents and adults, yet pediatric population-based data are lacking. The objective of this study was to determine the incidence of SP in the pediatric population in different age groups. METHODS This was a retrospective analysis of patients aged 0 to 17 years hospitalized with a diagnosis of SP from the Healthcare Cost and Utilization Project Kids' Inpatient Database between 1997 and 2006. Trends of overall incidence and demographic information, including age, sex, length of stay, associated procedures, and associated conditions, were obtained and analyzed. RESULTS The overall incidence of SP in children younger than 18 years increased from 2.68 per 100,000 population in 1997 to 3.41 per 100,000 in 2006. Average age (15.1 years; SE, 0.1 years), age distribution (83% = 15-17 years old), and hospital length of stay (4.7 days; SE, 0.1 days) remained constant. Between 1997 and 2006, males rose from 3.7 times to 4.2 times as likely to develop SP as females. In 2006, 70% of all hospitalized SP patients had therapeutic procedures documented: chest tube (32%), bleb excision (20%), and thoracotomy (8%) were the most common. Emphysematous bleb (21%), asthma (10%), and tobacco use (4%) were the most common associated diagnoses in 2006. CONCLUSIONS Although uncommon in children, SP appears to be primarily a condition of males and adolescents and appears to be increasing in incidence in this population. According to these data, a large portion of children are being managed without procedural intervention.
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Savasta S, Leoni MC, Strocchio L, Pizzo D, Spartà MV, Lima M, Valli M, Marchi A. A rare cause of recurrent spontaneous pneumothorax. Clin Pediatr (Phila) 2011; 50:456-8. [PMID: 21525091 DOI: 10.1177/0009922810385571] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Salvatore Savasta
- Fondazione IRCCS Policlinico San Matteo, viale Golgi 2, University of Pavia, Pavia, Italy.
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Efficacy of Blebs Detection for Preventive Surgery in Children’s Idiopathic Spontaneous Pneumothorax. World J Surg 2009; 34:185-9. [DOI: 10.1007/s00268-009-0286-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Robinson PD, Cooper P, Ranganathan SC. Evidence-based management of paediatric primary spontaneous pneumothorax. Paediatr Respir Rev 2009; 10:110-7; quiz 117. [PMID: 19651381 DOI: 10.1016/j.prrv.2008.12.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The exact incidence of paediatric primary spontaneous pneumothorax (PSP) is unclear, although PSP incidence in the general population is between 6 and 18 per 100,000. PSP has been reported throughout the paediatric age range. A potential genetic predisposition for familial cases has been recently identified. Whilst there is universal consensus on the management of tension pneumothorax, lack of agreement and consistency exists across a wide range of management issues for other aspects of PSP management. Paediatric PSP may have a higher recurrence rate than adult PSP, and the presence of apical lung cysts or bullae is not predictive of recurrence. The decision for surgical intervention should be based on documented recurrence. There is a lack of paediatric evidence to guide management decisions, and extrapolation of predominantly adult data to younger age groups should not be encouraged. Given the relatively low apparent incidence, a multicentre approach to future research is required in order to generate the evidence required for informed management of PSP in children.
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Affiliation(s)
- Paul D Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, NSW, 2145 Australia.
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O'Lone E, Elphick HE, Robinson PJ. Spontaneous pneumothorax in children: when is invasive treatment indicated? Pediatr Pulmonol 2008; 43:41-6. [PMID: 18041754 DOI: 10.1002/ppul.20734] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A retrospective review of pneumothoraces in children presenting to a major tertiary children's hospital is described. A total of 35 cases in 31 patients of spontaneous pneumothorax were identified over a 10-year period. There was one case of bilateral pneumothorax and three cases of recurrent pneumothoraces. Twenty-four cases (69%) required intercostal tube catheter drainage for a mean of 4.9 days (range 2-10 days). Eleven cases, including two cases in CF patients, and three cases in patients with Marfan's Syndrome proceeded to a secondary surgical procedure after a continuing air leak was present for an average of 5.9 days (range 2-16 days). In follow-up studies on 11 cases, 5 (45%) were found to have apical abnormalities of the lung on CT scanning. Pneumothoraces were identified in six cases of patients with cystic fibrosis as well as four in patients with Marfan's Syndrome. This present study has suggested that unless intercostal catheter treatment resolves the air leak associated with a spontaneous pneumothorax within 5 days that surgical intervention is most likely to be required to achieve a full resolution.
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Affiliation(s)
- E O'Lone
- Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia
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Abstract
Thoracoscopy was initially described for use in children to obtain pulmonary biopsy samples in the immunocompromised patient. With refinements in technique, development of better instrumentation, and advances in pediatric anesthesia, there are now many diagnostic and therapeutic indications for the use of thoracoscopy in children. One of the most common indications includes pleural debridement for empyema. Many centers consider this the optimal approach for biopsy of mediastinal lesions and excision of bronchogenic or duplication cysts. The technique is useful for pleural disorders, such as spontaneous pneumothorax and chylothorax. Thoracoscopy has been used to achieve exposure for spinal diskectomy in children with thoracic scoliosis, and newer techniques are being developed in performing anatomic lobectomies, repair of esophageal atesias, and closure of diaphragmatic hernias. The role of the robot in pediatric thoracoscopy is still in the early stages of definition.
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Affiliation(s)
- Scott A Engum
- Indiana University School of Medicine, James Whitcomb Riley Hospital for Children, Indianapolis, Indiana 46202, USA.
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Choudhary AK, Sellars MEK, Wallis C, Cohen G, McHugh K. Primary spontaneous pneumothorax in children: the role of CT in guiding management. Clin Radiol 2005; 60:508-11. [PMID: 15767109 DOI: 10.1016/j.crad.2004.12.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2004] [Revised: 11/21/2004] [Accepted: 12/01/2004] [Indexed: 10/25/2022]
Abstract
AIM Primary spontaneous pneumothorax (PSP) is rare in older children and most likely to be associated with apical subpleural blebs; there is a significant risk of recurrence. Our aim was to assess the radiological findings and final treatment of PSP in children presenting at our institution. METHODS The study included 3 children presenting over a 15-month period at our institution with PSP; the clinical features at presentation and examination findings were recorded. The chest radiographic and CT appearances and findings at surgery were reviewed. RESULTS In all cases, chest pain and breathlessness were presenting features and initial treatment included intercostal chest drainage. Chest radiographs on admission raised the suspicion of unilateral apical blebs in 2 children and bilateral apical blebs in the 3rd. Chest CT demonstrated apical blebs/cysts in all 3 children. The cysts ranged in size from 0.5 to 3.0 cm and were bilateral in 2 children. Surgery confirmed the radiological findings in all cases. CONCLUSION CT is of value in the detection of apical pleural blebs in children with PSP. On CT, particular attention should be paid to the lung apices, where majority of blebs in otherwise healthy young patients are located. Prompt diagnosis of a morphological abnormality in these children is likely to expedite definitive surgical treatment.
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Affiliation(s)
- A K Choudhary
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK.
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Abstract
BACKGROUND The purpose of the present study was to investigate the etiological factors, symptomatology, management and outcome of spontaneous pneumothorax in children aged <15 years. METHODS The authors' reviewed the records of 44 children with spontaneous pneumothorax between January 1990 and February 2002. RESULTS The median age was 4.6 years (range 2 months-14 years), and 51% were male. Breathlessness and coughing were the most common symptoms. All pneumothoraces were initially managed by closed tube drainage. Thirty-seven (84%) of the children responded well and were cured of pneumothorax with closed tube thoracostomy alone. Seven children (16%) underwent thoracotomy. The median hospital stay was 12.9 days. There were two deaths from respiratory failure. Six- to 96-month follow-up information was available for 32 patients, and only one recurrence was found. CONCLUSIONS Lung infections were the most frequently observed underlying pathology in the patients studied. Closed tube thoracostomy alone was sufficient for the majority of patients.
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Affiliation(s)
- Sevval Eren
- Department of Thoracic Surgery, Dicle University Medical School, Diyarbakir, Turkey.
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Cooper ES, Syring RS, King LG. Pneumothorax in cats with a clinical diagnosis of feline asthma: 5 cases (1990-2000). J Vet Emerg Crit Care (San Antonio) 2003. [DOI: 10.1046/j.1435-6935.2003.00081.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Spontaneous pneumothorax is rare in childhood. Before 12 years of age the main underlying pathologies are asthma, cystic malformations, post infectious bullae, and infectious pneumoniae. After 12 years of age it is mainly associated with cystic fibrosis and constitutional slim morphology. Symptoms vary according to the extent of lung collapse and the diagnosis is confirmed on chest X rays. In mildly symptomatic pneumothorax, spontaneous resolution is achieved within few days. When cardiorespiratory difficulties are present, mechanical evacuation of air from the pleural cavity is necessary through a tube drainage maintained until complete pulmonary reexpansion. Surgical treatment is indicated in case of persisting air leakage after one week of efficient drainage, large cystic malformation or post infectious bullae, recurring or bilateral pneumothorax.
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Affiliation(s)
- J L Michel
- Service de chirurgie infantile, CHD Félix Guyon, Saint-Denis, La Réunion
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Affiliation(s)
- L K Carlisle
- Department of Pediatrics, Louisiana State University Medical Center, New Orleans, USA
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