Management of pediatric occult pneumothorax in blunt trauma: a subgroup analysis of the American Association for the Surgery of Trauma multicenter prospective observational study

• Published in: Journal of pediatric surgery Vol. 47; no. 3; pp. 467 - 472
• Main Authors: Notrica, David M, Garcia-Filion, Pamela, Moore, Forrest O, Goslar, Pamela W, Coimbra, Raul, Velmahos, George, Stevens, Lily R, Petersen, Scott R, Brown, Carlos V.R, Foulkrod, Kelli H, Coopwood, Thomas B, Lottenberg, Lawrence, Phelan, Herb A, Bruns, Brandon, Sherck, John P, Norwood, Scott H, Barnes, Stephen L, Matthews, Marc R, Hoff, William S, deMoya, Marc A, Bansal, Vishal, Hu, Charles K.C, Karmy-Jones, Riyad C, Vinces, Fausto, Hill, Jenessa, Pembaur, Karl, Haan, James M
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2012
• Subjects: Adolescent; Chest tube thoracostomy; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Occult pneumothorax; Pediatric trauma; Pediatrics; Pneumothorax; Pneumothorax - diagnostic imaging; Pneumothorax - etiology; Pneumothorax - therapy; Positive pressure ventilation; Positive-Pressure Respiration; Rib fractures; Rib Fractures - complications; Surgery; Thoracostomy; Tomography, X-Ray Computed; Treatment Outcome; Watchful Waiting; Wounds, Nonpenetrating - complications; Positive pressure ventilation; Pediatric trauma; Pneumothorax; Rib fractures; Occult pneumothorax; Chest tube thoracostomy
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2011.09.037

Abstract Background Occult pneumothorax (OPTX) represents air within the pleural space not visible on conventional chest radiographs. Increased use of computed tomography has led to a rise in the detection of OPTX. Optimal management remains undefined. Methods A pediatric subgroup analysis (age <18 years) from a multicenter, observational study evaluating OPTX management. Data analyzed were pneumothorax size, management outcome, and associated risk factors to characterize those that may be safely observed. Results Fifty-two OPTX (7.3 ± 6.2 mm) in 51 patients were identified. None were greater than 27 mm; all those under 16.5 mm (n = 48) were successfully managed without intervention. Two patients underwent initial tube thoracostomy (one [21 mm] and the other with bilateral OPTX [24 mm, 27 mm]). Among patients under observation (n = 49), OPTX size progressed in 2; one (6.4mm) required no treatment, while one (16.5 mm) received elective intervention. Respiratory distress occurred in one patient (10.7 mm) who did not require tube thoracostomy. Nine received positive pressure ventilation; 8 did not have a tube thoracostomy. Twenty-four patients (51%) had one or more rib fractures; 3 required tube thoracostomy. Conclusion No pediatric OPTX initially observed developed a tension pneumothorax or adverse event related to observation. Pediatric patients with OPTX less than 16 mm may be safely observed. Neither the presence of rib fractures nor need for PPV alone necessitates intervention.