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Asymptomatic Non-occult Pneumothorax in Pediatric Blunt Chest Trauma: Chest Tube versus Observation
Katrina L. Weaver, MD, Valerie A. Waddell, MS, CPNP-AC, Joanna L. Gould, MD, Ashwini S. Poola, MD, Pablo Aguayo, MD, Shawn D. St. Peter, MD, David Juang, MD. Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA.

Background: The treatment of asymptomatic non-occult pneumothoraces (ANOPTX) secondary to blunt chest trauma (BCT) has not been well delineated. We sought to analyze our experience with these conditions in the pediatric trauma patient and determine if a chest tube is mandatory.

Methods: A retrospective review was conducted on patients sustaining BCT at a single level one pediatric hospital, between January 2000 and June 2015. Patients with ANOPTX or pneumomediastinum with PTX were identified. NOPTX were defined as apical, small (<10%), and moderate (10-20%). These patients were further divided into two groups: chest tube (CT) versus observation. Data analyzed included patient demographics, admission vitals, trauma scores, interventions, complications, and disposition at discharge.

Results: 85 clinically stable patients were found to have an ANOPTX, 6 of which had a combined pneumothorax and pneumomediastinum. 48 (56%) were managed with observation only, while the remaining 37 underwent CT insertion. No statistical difference was found between groups in admission vitals (RR, HR, BP, O2 sat), GCS or ISS scores. The distribution of NOPTX sizes and hospital length of stay are shown in Table 1. 73% (35/48) of those ANOPTX observed resolved over a median of 24 hrs (range 13.3 -43.3) and no one in either group had a recurrence of pneumothorax after discharge.

Conclusions: It appears that ANOPTX can be safely managed with observation in the pediatric trauma patient.

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