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Spontaneous pneumothorax in children: the problem with rare presentations

Spontaneous pneumothorax in children and young people is relatively rare. Although the exact incidence is unclear, the most recent estimates, based on US data, give paediatric figures for spontaneous pneumothorax of 4 per 100 000 population/year in males and 1.1 per 100 000 population/year in females.1 Given the low incidence and lack of good quality clinical data, it is regrettable, but unsurprising, that the evidence base regarding optimal management in the paediatric population is limited.

The Robinson et al 2 paper is a multicentre retrospective chart review of primary spontaneous pneumothorax (PSP) and secondary spontaneous pneumothorax (SSP) over 7 years (2003–2010), undertaken by the Paediatric Research in Emergency Departments International Collaborative (PREDICT)—a network of nine paediatric emergency departments (EDs) in Australia and New Zealand.

The paper provides useful reminders regarding the epidemiology of PSP and SSP. During the 7-year study period, there were only 219 presentations (an average of just over 30 per year) across the nine sites. The most common presenting complaint was chest pain (87%), followed by dyspnoea (43%). The median age at initial presentation was 15.2 years, and only 13% presented under the age of 13 years. The majority of patients were male (68% PSP; 81% SSP).

These data underscore the difficulty faced by paediatric trainees in achieving competence in the management of spontaneous pneumothorax (whether PSP or SSP). The relative rarity of this condition means that exposure to, and experience …