title: What factors predict recurrence after an initial episode of primary spontaneous pneumothorax in children?
abstract: OBJECTIVE
  Recurrence is the most common complication after an initial episode of primary spontaneous pneumothorax (PSP). However, preventive surgery in children remains a controversial issue. The purpose of this study was to determine predictive factors of recurrence to better inform early surgical referrals.
  
  
  METHODS
  We retrospectively reviewed all consecutive patients under 18 years of age who conservatively treated for an initial episode of PSP between March 2005 and September 2011.
  
  
  RESULTS
  One hundred fourteen patients were included in this study. The mean follow-up period was 43.1 months. Ipsilateral and contralateral recurrence developed in 47.3% and 14.0% of patients. The risk of ipsilateral recurrence for patients with or without air-containing lesions according to high-resolution computed tomography (HRCT) was 60.3% and 31.4%. In the multivariate analysis, the presence of air-containing lesions on HRCT scans and bullae on chest X-rays were independent risk factors for ipsilateral recurrence.
  
  
  CONCLUSIONS
  The presence of bleb or bullae on HRCT scans or chest X-rays after an initial episode of PSP was significantly related to the ipsilateral recurrence in children. If the risk factors are clarified in further studies, hospital stays and the recurrence of PSP after the first episode could be reduced with early video-assisted thoracoscopic surgery.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea.
authors.forename: Si
authors.initials: S
authors.lastname: Young Choi
authors.forename: Chan
authors.initials: C
authors.lastname: Beom Park
authors.forename: Sun
authors.initials: S
authors.lastname: Wha Song
authors.forename: Yong
authors.initials: Y
authors.lastname: Hwan Kim
authors.forename: Seong
authors.initials: S
authors.lastname: Cheol Jeong
authors.forename: Kyung
authors.initials: K
authors.lastname: Soo Kim
authors.forename: Keon
authors.initials: K
authors.lastname: Hyon Jo
mesh_terms: D000293:Adolescent; D000367:Age Factors; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D011030:Pneumothorax / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D012720:Severity of Illness Index; D020775:Thoracic Surgery, Video-Assisted; D013997:Time Factors; D016896:Treatment Outcome