Changing the Paradigm for Management of Pediatric Primary Spontaneous Pneumothorax: A Simple Aspiration Test Predicts Need for Operation
| Autor: | Michael A. Helmrath, Charles M Leys, Nicholas Marka, Mary E. Fallat, Peter C. Minneci, Amy E. Lawrence, Ninette Musili, Grace Z. Mak, Samir K. Gadepalli, Brad W. Warner, Shawn D. St. Peter, Beth Rymeski, Devin R. Halleran, Rashmi Kabre, Matthew P. Landman, Cynthia D. Downard, Ronald B. Hirschl, Jacqueline M. Saito, R. Cartland Burns, Linda Cherney-Stafford, Michelle Knezevich, Jason D. Fraser, Dave R. Lal, Thomas T. Sato, Daniel J. Ostlie, Julia Grabowski, Jonathan E. Kohler, David S. Foley |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Thoracentesis medicine.medical_treatment Pilot Projects 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Recurrence 030225 pediatrics medicine Humans Prospective Studies Treatment Failure Child Thoracic Surgery Video-Assisted business.industry Pneumothorax General Medicine Primary spontaneous pneumothorax Pigtail catheter medicine.disease Management algorithm Surgery Test (assessment) Chest tube Chest Tubes 030220 oncology & carcinogenesis Pediatrics Perinatology and Child Health Persistent air leak Female Level iii business |
| Zdroj: | Journal of Pediatric Surgery. 55:169-175 |
| ISSN: | 0022-3468 |
| DOI: | 10.1016/j.jpedsurg.2019.09.043 |
| Popis: | Purpose 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. Type of study Prospective pilot study Level of evidence Level III. |
| Databáze: | OpenAIRE |
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