title: Management of paediatric spontaneous pneumothorax: a multicentre retrospective case series.
abstract: OBJECTIVE
  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.
authors: 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.
authors: Paul D
authors: PD
authors: Robinson
authors: Royal Children's Hospital, Murdoch Children's Research Institute and University of Melbourne, Melbourne, Australia.
authors: Carol
authors: C
authors: Blackburn
authors: Royal Children's Hospital, Murdoch Children's Research Institute and University of Melbourne, Melbourne, Australia.
authors: Franz E
authors: FE
authors: Babl
authors: Emergency Department, Children, Youth and Women's Health Service, Adelaide, Australia.
authors: Lalith
authors: L
authors: Gamage
authors: Emergency Department, Children, Youth and Women's Health Service, Adelaide, Australia.
authors: Jacquie
authors: J
authors: Schutz
authors: Emergency Department, Sydney Children's Hospital, Sydney, Australia.
authors: Rebecca
authors: R
authors: Nogajski
authors: Starship Hospital, Auckland, New Zealand Liggins Institute, University of Auckland, New Zealand.
authors: Stuart
authors: S
authors: Dalziel
authors: Starship Hospital, Auckland, New Zealand.
authors: Colin B
authors: CB
authors: Donald
authors: Emergency Medicine Department, Sunshine Hospital, St Albans, Victoria, Australia.
authors: Dino
authors: D
authors: Druda
authors: Emergency Medicine Department, Sunshine Hospital, St Albans, Victoria, Australia.
authors: David
authors: D
authors: Krieser
authors: Emergency Medicine Department, Kidzfirst Middlemore Hospital, Otahuhu, New Zealand.
authors: Jocelyn
authors: J
authors: Neutze
authors: Emergency Medicine Department, Royal Children's Hospital, Brisbane, Australia.
authors: Jason
authors: J
authors: Acworth
authors: Emergency Medicine Department, John Hunter Hospital, Newcastle, New South Wales, Australia.
authors: Mark
authors: M
authors: Lee
authors: Department of Respiratory Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia.
authors: Peter K
authors: PK
authors: Ngo
mesh_terms: D000293:Adolescent; D001315:Australia; D002648:Child; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D009520:New Zealand; D011030:Pneumothorax / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Accident & Emergency; Paediatric Practice; Respiratory