Failed Aspiration Predicts Need for Operation in Spontaneous Pneumothorax

Infographic · Jan 2020 · 1 min read

In brief

Multi-center prospective study of 33 pediatric patients demonstrates that failed simple aspiration test predicts chest tube failure with 83% positive predictive value in primary spontaneous pneumothorax. Authors recommend proceeding directly to VATS after failed aspiration rather than prolonged chest tube management.

Simple aspiration test predicts chest tube failure with 83% positive predictive value in pediatric primary spontaneous pneumothorax
Patients who fail initial aspiration have significantly higher recurrence rates (83% vs 44%) compared to those who pass
Failed aspiration should prompt direct progression to VATS rather than prolonged chest tube management
Initial aspiration test can streamline management and reduce unnecessary hospitalizations in pediatric PSP
83% of patients who failed aspiration and underwent chest tube management ultimately required VATS or had recurrence

Written by the GCMD Library team from the infographic.

The infographic is divided into three sections with a dark blue background on the left and teal on the right. The left panel shows a rib cage illustration with a syringe, an hourglass icon, and checkmark/X symbols with associated statistics. The right panel displays predictive values and a flowchart algorithm with gray boxes and diamond decision points. The Journal of Pediatric Surgery logo appears at the bottom left.

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.