Faculty Collaboration Database

Changing the Paradigm for Management of Pediatric Primary Spontaneous Pneumothorax: A Simple Aspiration Test Predicts Need for Operation. J Pediatr Surg 2020 Jan;55(1):169-175

Date

11/11/2019

Pubmed ID

31706614

DOI

10.1016/j.jpedsurg.2019.09.043

Scopus ID

2-s2.0-85075535644 (requires institutional sign-in at Scopus site)   18 Citations

Abstract

PURPOSE: Chest tube (CT) management for pediatric primary spontaneous pneumothorax (PSP) is associated with long hospital stays and high recurrence rates. To streamline management, we explored simple aspiration as a test to predict need for surgery.

METHODS: A multi-institution, prospective pilot study of patients with first presentation for PSP at 9 children's hospitals was performed. Aspiration was performed through a pigtail catheter, followed by 6 h observation with CT clamped. If pneumothorax recurred during observation, the aspiration test failed and subsequent management was per surgeon discretion.

RESULTS: Thirty-three patients were managed with simple aspiration. Aspiration was successful in 16 of 33 (48%), while 17 (52%) failed the aspiration test and required hospitalization. Twelve who failed aspiration underwent CT management, of which 10 (83%) failed CT management owing to either persistent air leak requiring VATS or subsequent PSP recurrence. Recurrence rate was significantly greater in the group that failed aspiration compared to the group that passed aspiration [10/12 (83%) vs 7/16 (44%), respectively, P=0.028].

CONCLUSION: Simple aspiration test upon presentation with PSP predicts chest tube failure with 83% positive predictive value. We recommend changing the PSP management algorithm to include an initial simple aspiration test, and if that fails, proceed directly to VATS.

TYPE OF STUDY: Prospective pilot study LEVEL OF EVIDENCE: Level III.

Author List

Leys CM, Hirschl RB, Kohler JE, Cherney-Stafford L, Marka N, Fallat ME, Gadepalli SK, Fraser JD, Grabowski J, Burns RC, Downard CD, Foley DS, Halleran DR, Helmrath MA, Kabre R, Knezevich MS, Lal DR, Landman MP, Lawrence AE, Mak GZ, Minneci PC, Musili N, Rymeski B, Saito JM, Sato TT, St Peter SD, Warner BW, Ostlie DJ, Midwest Pediatric Surgery Consortium MWPSC

Author

Dave Lal MD, MPH Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Chest Tubes
Child
Female
Humans
Male
Pilot Projects
Pneumothorax
Predictive Value of Tests
Prospective Studies
Recurrence
Thoracentesis
Thoracic Surgery, Video-Assisted
Treatment Failure