title: Management of pediatric occult pneumothorax in blunt trauma: a subgroup analysis of the American Association for the Surgery of Trauma multicenter prospective observational study.
abstract: BACKGROUND
  Occult pneumothorax (OPTX) represents air within the pleural space not visible on conventional chest radiographs. Increased use of computed tomography has led to a rise in the detection of OPTX. Optimal management remains undefined.
  
  
  METHODS
  A pediatric subgroup analysis (age <18 years) from a multicenter, observational study evaluating OPTX management. Data analyzed were pneumothorax size, management outcome, and associated risk factors to characterize those that may be safely observed.
  
  
  RESULTS
  Fifty-two OPTX (7.3 ± 6.2 mm) in 51 patients were identified. None were greater than 27 mm; all those under 16.5 mm (n = 48) were successfully managed without intervention. Two patients underwent initial tube thoracostomy (one [21 mm] and the other with bilateral OPTX [24 mm, 27 mm]). Among patients under observation (n = 49), OPTX size progressed in 2; one (6.4mm) required no treatment, while one (16.5 mm) received elective intervention. Respiratory distress occurred in one patient (10.7 mm) who did not require tube thoracostomy. Nine received positive pressure ventilation; 8 did not have a tube thoracostomy. Twenty-four patients (51%) had one or more rib fractures; 3 required tube thoracostomy.
  
  
  CONCLUSIONS
  No pediatric OPTX initially observed developed a tension pneumothorax or adverse event related to observation. Pediatric patients with OPTX less than 16 mm may be safely observed. Neither the presence of rib fractures nor need for PPV alone necessitates intervention.
authors.affiliation: Phoenix Children's Hospital, Phoenix, AZ, USA. dnotrica@phoenixchildrens.com
authors.forename: David M
authors.initials: DM
authors.lastname: Notrica
authors.forename: Pamela
authors.initials: P
authors.lastname: Garcia-Filion
authors.forename: Forrest O
authors.initials: FO
authors.lastname: Moore
authors.forename: Pamela W
authors.initials: PW
authors.lastname: Goslar
authors.forename: Raul
authors.initials: R
authors.lastname: Coimbra
authors.forename: George
authors.initials: G
authors.lastname: Velmahos
authors.forename: Lily R
authors.initials: LR
authors.lastname: Stevens
authors.forename: Scott R
authors.initials: SR
authors.lastname: Petersen
authors.forename: Carlos V R
authors.initials: CV
authors.lastname: Brown
authors.forename: Kelli H
authors.initials: KH
authors.lastname: Foulkrod
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Coopwood
authors.forename: Lawrence
authors.initials: L
authors.lastname: Lottenberg
authors.forename: Herb A
authors.initials: HA
authors.lastname: Phelan
authors.forename: Brandon
authors.initials: B
authors.lastname: Bruns
authors.forename: John P
authors.initials: JP
authors.lastname: Sherck
authors.forename: Scott H
authors.initials: SH
authors.lastname: Norwood
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Barnes
authors.forename: Marc R
authors.initials: MR
authors.lastname: Matthews
authors.forename: William S
authors.initials: WS
authors.lastname: Hoff
authors.forename: Marc A
authors.initials: MA
authors.lastname: Demoya
authors.forename: Vishal
authors.initials: V
authors.lastname: Bansal
authors.forename: Charles K C
authors.initials: CK
authors.lastname: Hu
authors.forename: Riyad C
authors.initials: RC
authors.lastname: Karmy-Jones
authors.forename: Fausto
authors.initials: F
authors.lastname: Vinces
authors.forename: Jenessa
authors.initials: J
authors.lastname: Hill
authors.forename: Karl
authors.initials: K
authors.lastname: Pembaur
authors.forename: James M
authors.initials: JM
authors.lastname: Haan
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D011175:Positive-Pressure Respiration; D012253:Rib Fractures / Q000150:complications; D013907:Thoracostomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D057832:Watchful Waiting; D014949:Wounds, Nonpenetrating / Q000150:complications*