Background: There are no guideline which dictate management of spontaneous pneumothorax in children. The objective of this study was to evaluate the practice variation in the management of a first episode of spontaneous pneumothorax in children.
Methods: This was a retrospective chart review of all children visiting a tertiary care pediatric hospital for a first episode of spontaneous pneumothorax from January 2008 to December 2017. The primary outcome was the first-line therapeutic approach used to manage the pneumothorax (observation, oxygen, needle aspiration, inter-costal chest tube, surgery). All charts were evaluated by a single rater using a standardized report form and 20% of them were evaluated in duplicate. The primary analysis was the proportion of the different first and last-line therapeutic approaches used. Secondary analysis evaluated the association between first-line therapy and probability of success using chi-square.
Results: During the study period, 76 children/episodes were deemed eligible, classified as follows: 59 with a primary and 17 with a secondary spontaneous pneumothorax. The most common first-line therapeutic approaches used were chest tube (31), oxygen alone (27) and observation (14). The most common definitive therapeutic approaches were Chest tube (27), oxygen (21), observation (13) and surgery (8). No difference was found between the therapeutic approaches with respect to the success rate for the primary (chi-square 4.92, 3DF, p= 0.18) or secondary spontaneous pneumothorax (chi-square 2.55, 2DF, p= 0.28).
Conclusion: Chest tube insertion was the first line of treatment in more than 40% of children with a first episode of spontaneous pneumothorax while a conservative approach was used in 54%.