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

David M. Notrica, Pamela Garcia-Filion, Forrest O. Moore, Pamela W. Goslar, Raul Coimbra, George Velmahos, Lily R. Stevens, Scott R. Petersen, Carlos V R Brown, Kelli H. Foulkrod, Thomas B. Coopwood, Lawrence Lottenberg, Herb A. Phelan, Brandon Bruns, John P. Sherck, Scott H. Norwood, Stephen L. Barnes, Marc R. Matthews, William S. Hoff, Marc A. DemoyaVishal Bansal, Charles K C Hu, Riyad C. Karmy-Jones, Fausto Vinces, Jenessa Hill, Karl Pembaur, James M. Haan

Research output: Contribution to journalArticle

13 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)467-472
Number of pages6
JournalJournal of Pediatric Surgery
Volume47
Issue number3
DOIs
StatePublished - Mar 1 2012

Keywords

  • Chest tube thoracostomy
  • Occult pneumothorax
  • Pediatric trauma
  • Pneumothorax
  • Positive pressure ventilation
  • Rib fractures

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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    Notrica, D. M., Garcia-Filion, P., Moore, F. O., Goslar, P. W., Coimbra, R., Velmahos, G., Stevens, L. R., Petersen, S. R., Brown, C. V. R., Foulkrod, K. H., Coopwood, T. B., Lottenberg, L., Phelan, H. A., Bruns, B., Sherck, J. P., Norwood, S. H., Barnes, S. L., Matthews, M. R., Hoff, W. S., ... Haan, J. M. (2012). Management of pediatric occult pneumothorax in blunt trauma: A subgroup analysis of the American Association for the Surgery of Trauma multicenter prospective observational study. Journal of Pediatric Surgery, 47(3), 467-472. https://doi.org/10.1016/j.jpedsurg.2011.09.037