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Factors associated with proceeding to surgical intervention and recurrence of primary spontaneous pneumothorax in adolescent patients

European Journal of Pediatrics volume 173, pages 1483–1490 (2014)Cite this article

Abstract

Primary spontaneous pneumothorax (PSP) is not uncommon, and its recurrence is often a challenging clinical problem. Surgical management and predisposing factors for the recurrence of PSP, however, have not yet been well elucidated in adolescent patients. The major aim of this study was to investigate factors associated with proceeding to surgical intervention and recurrence of PSP in adolescents. Two hundred and nineteen episodes of PSP in 171 adolescent patients were retrospectively reviewed. The clinical and radiological spectrum of PSP and factors for proceeding to surgical intervention were assessed in these 171 patients. Risk factors for the recurrence of PSP were further analyzed in 128 patients with first attack of PSP. The male-to-female ratio of the 171 PSP patients was 9:1, and the mean age was 17.6 ± 1.5 years. The median body mass index (BMI) percentile was 11 (range 2–31), and 45 (34 %) patients had underweight BMI. The incidence of recurrent PSP was high with a total recurrence rate of 21 %. Ipsilateral recurrence rate of PSP after video-assisted thoracoscopic surgery (VATS) was much less than that of the conservative treatment (4 vs. 18 %). A large-size pneumothorax with a persistent air leak was the most significant factor for proceeding to VATS surgery (P = 0.001). In addition, it was a significant factor influencing the recurrence of PSP (P = 0.014). Other factors that did not significantly affect the recurrence rate were BMI, smoking status, and the number of bullae. Conclusion: Adolescent PSP has a high recurrence rate of 21 % after a 2-year follow-up. A large-size pneumothorax with a persistent air leak may not only lead to surgical intervention but also the risk of a recurrence of PSP. The initial size of pneumothorax may not only guide the management process but also predict the risk of a recurrence in adolescent patients with PSP.

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Fig. 1
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Abbreviations

BMI:

Body mass index

CXR:

Chest X-ray

HRCT:

High-resolution computed tomography

PA:

Posteroanterior

PSP:

Primary spontaneous pneumothorax

VATS:

Video-assisted thoracoscopic surgery

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Conflict of interest

This work was supported by CMRPG2B0391 from the Chang Gung Medical foundation, Chang Gung University, Taiwan. The authors report no conflicts of interest or any financial relationship with the organization that sponsored this research and are responsible for the content and writing of the paper.

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Affiliations

  1. Department of Pediatrics, Chang Gung Memorial Hospital, Keelung, Taiwan

    Chih-Yung Chiu, Chia-Jung Wang & Ming-Han Tsai

  2. Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Chih-Yung Chiu

  3. Department of Thoracic & Cardiovascular Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan

    Tzu-Ping Chen

  4. Department of Pediatrics, Division of Pediatric Pulmonology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 5, Fu-Hsin Street, Kueishan, Taoyuan, Taiwan

    Kin-Sun Wong

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  1. Chih-Yung Chiu
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  2. Tzu-Ping Chen
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  3. Chia-Jung Wang
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  4. Ming-Han Tsai
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Correspondence to Kin-Sun Wong.

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Communicated by Peter de Winter

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Chiu, CY., Chen, TP., Wang, CJ. et al. Factors associated with proceeding to surgical intervention and recurrence of primary spontaneous pneumothorax in adolescent patients. Eur J Pediatr 173, 1483–1490 (2014). https://doi.org/10.1007/s00431-014-2352-0

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  • DOI: https://doi.org/10.1007/s00431-014-2352-0

Keywords

  • Large-size pneumothorax
  • Primary spontaneous pneumothorax
  • Recurrence
  • Surgical intervention