Management of primary spontaneous pneumothorax in Chinese children

Lilian PY Lee, Miranda HY Lai, WK Chiu, Michael WY Leung, Kelvin KW Liu, HB Chan
Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Kwun Tong, Hong Kong

OBJECTIVES. To (1) determine the demographics of Chinese children admitted with primary spontaneous pneumothorax, (2) suggest how they may be quantified radiologically, (3) compare the difference in outcomes after their primary management by thoracentesis and chest tube insertion, and (4) review the local experience with surgical intervention for such children.

DESIGN. Retrospective, descriptive study.

SETTING. Acute tertiary public hospital, Hong Kong.

PATIENTS. Consecutive patients younger than 18 years and admitted with primary spontaneous pneumothorax between 1 January 1999 and 30 September 2007.

MAIN OUTCOME MEASURES. Hospital stay and risk of recurrence after thoracentesis versus chest tube insertion.

RESULTS. Seventy-seven patients with 114 episodes of primary spontaneous pneumothorax were reviewed. They were significantly taller (P<0.001) and thinner (P<0.001) than the population mean percentile. Both the Light index and Collins formula were accurate in quantifying pneumothorax volume, but as the former was simpler and more user-friendly, this was more applicable in children. Thoracentesis resulted in shorter hospital stays (mean, 4.6; standard deviation, 1.9 days) than chest tube insertion (6.9; 3.0 days), but there was no significant difference in the recurrence rates within 6 months (P=1.0), 1 year (P=0.9), and 2 years (P=0.1). Insignificant pneumothorax was treated with observation alone in 16% of the patients. For patients with a clinically significant pneumothorax, thoracentesis and chest tube insertion were successful in 78% and 67%, respectively (P=0.34). The success rate of video-assisted thoracoscopic surgery was 89%, and postoperative recurrence occurred more commonly in patients without a lung bleb.

CONCLUSION. Chinese children with primary spontaneous pneumothorax exhibited similar demographic characteristics to Caucasian children. Light index is simple and accurate for quantifying pneumothorax volume in children. Conservative treatment including observation, thoracentesis, and chest tube insertion should suffice for most patients with first episode of primary spontaneous pneumothorax. Early surgery is warranted for any patient who fails conservative treatment, for which video-assisted thoracoscopic surgery is safe and effective.

Hong Kong Med J 2010;16:94-100

Key words: Chest tubes; Child; Pneumothorax; Recurrence; Treatment outcome