TY - JOUR
T1 - Evaluation and Management of Primary Spontaneous Pneumothorax in Adolescents and Young Adults
T2 - A Systematic Review From the APSA Outcomes & Evidence-Based Practice Committee
AU - the APSA Outcomes and Evidence Based Practice Committee
AU - Speck, K. Elizabeth
AU - Kulaylat, Afif N.
AU - Baerg, Joanne E.
AU - Acker, Shannon N.
AU - Baird, Robert
AU - Beres, Alana L.
AU - Chang, Henry
AU - Derderian, S. Christopher
AU - Englum, Brian
AU - Gonzalez, Katherine W.
AU - Kawaguchi, Akemi
AU - Kelley-Quon, Lorraine
AU - Levene, Tamar L.
AU - Rentea, Rebecca M.
AU - Rialon, Kristy L.
AU - Ricca, Robert
AU - Somme, Stig
AU - Wakeman, Derek
AU - Yousef, Yasmine
AU - St. Peter, Shawn D.
AU - Lucas, Donald J.
N1 - Funding Information:
Mark MacEachern, Informaticist, Research and Informatics, Taubman Health Sciences Library, University of Michigan.
Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2023/10
Y1 - 2023/10
N2 - Introduction: Controversy exists in the optimal management of adolescent and young adult primary spontaneous pneumothorax. The American Pediatric Surgical Association (APSA) Outcomes and Evidence-Based Practice Committee performed a systematic review of the literature to develop evidence-based recommendations. Methods: Ovid MEDLINE, Elsevier Embase, EBSCOhost CINAHL, Elsevier Scopus, and Wiley Cochrane Central Register of Controlled Trials databases were queried for literature related to spontaneous pneumothorax between January 1, 1990, and December 31, 2020, addressing (1) initial management, (2) advanced imaging, (3) timing of surgery, (4) operative technique, (5) management of contralateral side, and (6) management of recurrence. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines were followed. Results: Seventy-nine manuscripts were included. Initial management of adolescent and young adult primary spontaneous pneumothorax should be guided by symptoms and can include observation, aspiration, or tube thoracostomy. There is no evidence of benefit for cross-sectional imaging. Patients with ongoing air leak may benefit from early operative intervention within 24–48 h. A video-assisted thoracoscopic surgery (VATS) approach with stapled blebectomy and pleural procedure should be considered. There is no evidence to support prophylactic management of the contralateral side. Recurrence after VATS can be treated with repeat VATS with intensification of pleural treatment. Conclusions: The management of adolescent and young adult primary spontaneous pneumothorax is varied. Best practices exist to optimize some aspects of care. Further prospective studies are needed to better determine optimal timing of operative intervention, the most effective operation, and management of recurrence after observation, tube thoracostomy, or operative intervention. Level of Evidence: Level 4. Type of study: Systematic Review of Level 1–4 studies.
AB - Introduction: Controversy exists in the optimal management of adolescent and young adult primary spontaneous pneumothorax. The American Pediatric Surgical Association (APSA) Outcomes and Evidence-Based Practice Committee performed a systematic review of the literature to develop evidence-based recommendations. Methods: Ovid MEDLINE, Elsevier Embase, EBSCOhost CINAHL, Elsevier Scopus, and Wiley Cochrane Central Register of Controlled Trials databases were queried for literature related to spontaneous pneumothorax between January 1, 1990, and December 31, 2020, addressing (1) initial management, (2) advanced imaging, (3) timing of surgery, (4) operative technique, (5) management of contralateral side, and (6) management of recurrence. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines were followed. Results: Seventy-nine manuscripts were included. Initial management of adolescent and young adult primary spontaneous pneumothorax should be guided by symptoms and can include observation, aspiration, or tube thoracostomy. There is no evidence of benefit for cross-sectional imaging. Patients with ongoing air leak may benefit from early operative intervention within 24–48 h. A video-assisted thoracoscopic surgery (VATS) approach with stapled blebectomy and pleural procedure should be considered. There is no evidence to support prophylactic management of the contralateral side. Recurrence after VATS can be treated with repeat VATS with intensification of pleural treatment. Conclusions: The management of adolescent and young adult primary spontaneous pneumothorax is varied. Best practices exist to optimize some aspects of care. Further prospective studies are needed to better determine optimal timing of operative intervention, the most effective operation, and management of recurrence after observation, tube thoracostomy, or operative intervention. Level of Evidence: Level 4. Type of study: Systematic Review of Level 1–4 studies.
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U2 - 10.1016/j.jpedsurg.2023.03.018
DO - 10.1016/j.jpedsurg.2023.03.018
M3 - Article
C2 - 37130765
AN - SCOPUS:85154546618
SN - 0022-3468
VL - 58
SP - 1873
EP - 1885
JO - Journal of pediatric surgery
JF - Journal of pediatric surgery
IS - 10
ER -