Conservative and operative management of spontaneous pneumothorax in children and adolescents: Are we abusing of CT?

Zarfati, Angelo; Pardi, Valerio; Frediani, Simone; Aloi, Ivan Pietro; Accinni, Antonella; Bertocchini, Arianna; Madafferi, Silvia; Inserra, Alessandro

doi:10.1002/ppul.26703

Cited by 2 publications

(3 citation statements)

References 14 publications

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“…Among the cases that underwent a first-line operative management, the groups were similar even regarding the type of operative treatment (Drainage 44% vs. 36%, p = 0.720; Surgery 11% vs. 7%, p = 0.531). The patients with Marfan syndrome showed significantly more first-line treatment failures needing further surgery [44% (4) vs. 14% (8), p = 0.049]. However, the median hospitalization at first episode was similar among the groups [5 days (range 2-15) vs. 6 days (range 0-45), p = 0.603].…”

Section: Resultsmentioning

confidence: 99%

“…Our institution has recently developed a management protocol for spontaneous pneumothorax in children and adolescents ( 8 ). The protocol is based on the authors' expertise and experience, as well as recent literature ( 10 – 13 ).…”

Section: Discussionmentioning

confidence: 99%

“…The details and methodology of management of spontaneous pneumothorax in our institution have been recently published ( 8 ). Patients were defined as asymptomatic in the absence of symptoms, paucisymptomatic in case of mild chest pain, cough, or mild dyspnea, and highly symptomatic in the case of severe pain or dyspnea.…”

Section: Methodsmentioning

confidence: 99%

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Aggressive approach for spontaneous pneumothorax treatment in children with Marfan syndrome?

Zarfati,

Frediani,

Pardi

et al. 2023

Front. Pediatr.

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Background and objectivesMarfan syndrome (MS) is a systemic disease of connective tissues consisting of a variable combination of anomalies. These patients have an increased risk of spontaneous pneumothorax (SP). However, there is a scarcity of pediatric literature on management, and no specific guidelines exist. Our aim was to analyze the management of spontaneous pneumothorax in children and adolescents with Marfan syndrome, comparing syndromic and non-syndromic patients.MethodsRetrospective analysis of pediatric patients (18 years) with SP diagnosed at our tertiary pediatric hospital (January 10–June 22), with special emphasis on diagnosis, treatment, and follow-up (FU).ResultsSixty-six patients with SP were identified, with nine (13%) having MS. In terms of baseline, there were no significant differences between the groups (age, sex, asthma, symptoms, and side, first-line treatment and hospitalization length). Overall, Marfan patients had significantly more first-line treatment failures requiring additional surgery, as well as more contralateral occurrences and the need for surgery/chest drain during the follow-up. Instead, conservative management resulted in significantly more ipsilateral recurrences and the need for surgery/chest drain in Marfan patients than controls during the follow-up.ConclusionsTreatment failure, contralateral occurrence, ipsilateral recurrence, and the need for surgery/chest drain during follow-up make management of patients with Marfan syndrome and spontaneous pneumothorax more difficult. In patients with a diagnosed MS a more aggressive first-line management should be considered, bearing in mind the higher risks of this population.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Aggressive approach for spontaneous pneumothorax treatment in children with Marfan syndrome?

Zarfati,

Frediani,

Pardi

et al. 2023

Front. Pediatr.

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LARGE primary spontaneous pneumothorax (2023 French Guidelines definition): Do radiographic size matter in pediatric patients? A comparative analysis

Zarfati,

Rollo,

Frediani

et al. 2024

Pediatric Pulmonology

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PurposeOur aim was to explore the applicability of the definition of “large” primary spontaneous pneumothorax (PSP) of adult guidelines to pediatric patients.MethodsWe performed a retrospective monocentric analysis of first‐episodes of PSP (Period: January 2010–January 2023). We defined large PSP according to French SPLF/SMFU/SRLF/SFAR/SFCTCV Guidelines. Inclusion criteria: age 1−18 years‐old, follow‐up ≥ 1 year. We performed a comparative analysis between large and nonlarge PSP. We reported the categorical variables as frequencies, and continuous as median and range. We compared categorical variables using Chi‐Square or Fisher test, and continuous using U Mann–Whitney test. p < 0.05 was considered significant.ResultsThe population consisted of 49 patients, 15 (30%) with large PSP. We found no significant differences at presentation between large and nonlarge PSP regarding age, sex, side, BMI, oxygen saturation, respiratory rate and hearth rate. Conservative first‐line management was used significantly less for large PSP (26% vs. 82%, p = 0.0003), while drain more (46% vs. 8%, p = 0.005). The groups were similar regarding surgery. Large PSP had a significantly longer hospitalization (7 days vs. 4 days, p = 0.003). The incidence of first‐line management failure was similar between the groups. During the follow‐up, we found no significant differences regarding ipsilateral recurrence (33% vs. 17%, p = 0.275), and contralateral occurrence (0% vs. 5%, p = 1.000), need for drain (6% vs. 5%, p = 1.000), or surgery (33% vs. 14%, p = 0.246).ConclusionsIn the first‐line, large PSP were treated significantly less conservatively and more drained. Radiographic size of the pneumothorax does not seem to have an impact on first‐line treatment failure and follow‐up outcomes.

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Conservative and operative management of spontaneous pneumothorax in children and adolescents: Are we abusing of CT?

Cited by 2 publications

References 14 publications

Aggressive approach for spontaneous pneumothorax treatment in children with Marfan syndrome?

Aggressive approach for spontaneous pneumothorax treatment in children with Marfan syndrome?

LARGE primary spontaneous pneumothorax (2023 French Guidelines definition): Do radiographic size matter in pediatric patients? A comparative analysis

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