Primary spontaneous pneumothorax in children: factors predicting recurrence and contralateral occurrence
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In brief
In brief
This retrospective study of 63 pediatric PSP patients found that surgical intervention during the first episode significantly predicts contralateral occurrence (OR 32.0). CT scanning showed poor utility for bleb detection and recurrence prediction, challenging its routine use in pediatric PSP management.
Written by the GCMD Library team from the article.
Abstract
Background
The risk factors for recurrence in primary spontaneous pneumothorax (PSP) in children are not well known. We aimed to identify possible risk factors, and to evaluate the utility of computerised tomography (CT) scans in predicting future episodes.
Methods
We reviewed children aged < 18 years admitted to our institution for PSP from 2008 to 2017, excluding those with malignancies. Basic demographic data were extracted. Clinical data collected include pneumothorax laterality, CT results, treatment protocols and recurrences.
Results
63 patients were included, 19 (30.2%) of whom had CT scans. A total of 41 surgeries were performed. The median (interquartile range) age was 15.4 years (14.9–15.9), and body-mass index was 17.9 kg/m2 (15.8–19.3). 56 (88.9%) patients were male. Median follow-up duration was 19.8 months (11.6–35.9). Multivariate logistic regression analyses identified surgery in the first episode as a predictor for a subsequent contralateral occurrence (odds ratio [95% confidence interval] 32.026 [1.685–608.518], p = 0.021). No predictors for ipsilateral recurrence were found. CT scans were 76.5% sensitive for bleb detection, and predicted poorly for occurrence (positive predictive value 14.3%, likelihood ratio 1.1).
Conclusion
This is the first study demonstrating that surgery at first presentation appears to predict for occurrence of PSP on the contralateral lung. CT appears to be ineffective in detecting blebs and predicting PSP occurrence.