Paul D Robinson1, Carol Blackburn2, Franz E Babl2, Lalith Gamage3, Jacquie Schutz3, Rebecca Nogajski4, Stuart Dalziel5, Colin B Donald6, Dino Druda7, David Krieser7, Jocelyn Neutze8, Jason Acworth9, Mark Lee10, Peter K Ngo11. 1. 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. 2. Royal Children's Hospital, Murdoch Children's Research Institute and University of Melbourne, Melbourne, Australia. 3. Emergency Department, Children, Youth and Women's Health Service, Adelaide, Australia. 4. Emergency Department, Sydney Children's Hospital, Sydney, Australia. 5. Starship Hospital, Auckland, New Zealand Liggins Institute, University of Auckland, New Zealand. 6. Starship Hospital, Auckland, New Zealand. 7. Emergency Medicine Department, Sunshine Hospital, St Albans, Victoria, Australia. 8. Emergency Medicine Department, Kidzfirst Middlemore Hospital, Otahuhu, New Zealand. 9. Emergency Medicine Department, Royal Children's Hospital, Brisbane, Australia. 10. Emergency Medicine Department, John Hunter Hospital, Newcastle, New South Wales, Australia. 11. Department of Respiratory Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia.
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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Authors: Giampiero Soccorso; Ravindar Anbarasan; Michael Singh; Richard M Lindley; Sean S Marven; Dakshesh H Parikh Journal: Pediatr Surg Int Date: 2015-08-26 Impact factor: 1.827