{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T22:13:24Z","timestamp":1791756804833,"version":"4.3.4"},"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2021,4,30]],"date-time":"2021-04-30T00:00:00Z","timestamp":1619740800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Primary spontaneous pneumothorax (PSP) prevalence is typically higher in juvenile patients than in adults. We aimed to evaluate the optimal treatment for primary spontaneous pneumothorax and its efficacy and safety in juveniles.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Materials and methods<\/jats:title>\n<jats:p>We searched PubMed, Embase, and Cochrane databases for eligible studies published from database inception to October 10, 2020, and conducted a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary and secondary outcomes were recurrence rate and hospital stay length, respectively. Odds ratios (OR) and mean differences were used for quantitatively analyzing binary and continuous outcomes, respectively. In total, nine retrospective studies with 1,452 juvenile patients (aged &lt;21) were included for the quantitative analysis. The surgical approach led to a lower recurrence rate than did conservative approaches (OR: 1.95, 95% confidence interval: 1.15\u20133.32). Moreover, the recurrence rate was low in patients who underwent conservative treatment first and received surgery later.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Surgical approach for first-line management might have a greater effect on recurrence prevention than do conservative approaches. An upfront surgery might be an optimal choice for juvenile primary spontaneous pneumothorax.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0250929","type":"journal-article","created":{"date-parts":[[2021,4,30]],"date-time":"2021-04-30T17:24:36Z","timestamp":1619803476000},"page":"e0250929","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":14,"title":["Systematic review and meta-analysis on juvenile primary spontaneous pneumothorax: Conservative or surgical approach first?"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9713-7588","authenticated-orcid":true,"given":"Chun-Shan","family":"Hung","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0682-3716","authenticated-orcid":true,"given":"Yang-Ching","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ten-Fang","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fu-Huan","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,4,30]]},"reference":[{"issue":"7","key":"pone.0250929.ref001","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1097\/PEC.0b013e31825d2dd5","article-title":"Pediatric spontaneous pneumothorax","volume":"28","author":"K. 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Sterne","year":"2016","journal-title":"Bmj"},{"issue":"7414","key":"pone.0250929.ref011","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"J.P.T. Higgins","year":"2003","journal-title":"BMJ"},{"issue":"9","key":"pone.0250929.ref012","doi-asserted-by":"crossref","first-page":"1858","DOI":"10.1016\/j.jpedsurg.2017.11.047","article-title":"Optimal timing of video-assisted thoracoscopic surgery for primary spontaneous pneumothorax in children","volume":"53","author":"K. Williams","year":"2018","journal-title":"J Pediatr Surg"},{"issue":"10","key":"pone.0250929.ref013","doi-asserted-by":"crossref","first-page":"1960","DOI":"10.1016\/j.jpedsurg.2017.12.014","article-title":"Initial primary spontaneous pneumothorax in children and adolescents: Operate or wait?","volume":"53","author":"L.M. 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Hill","year":"1995","journal-title":"Ann Thorac Surg"},{"issue":"2","key":"pone.0250929.ref020","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1159\/000194541","article-title":"Noninvasive treatment of pneumothorax with oxygen inhalation","volume":"44","author":"T.S. Chadha","year":"1983","journal-title":"Respiration"},{"issue":"5779","key":"pone.0250929.ref021","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1136\/bmj.4.5779.86","article-title":"Oxygen therapy for spontaneous pneumothorax","volume":"4","author":"T.C. Northfield","year":"1971","journal-title":"Br Med J"},{"issue":"12","key":"pone.0250929.ref022","doi-asserted-by":"crossref","first-page":"5239","DOI":"10.21037\/jtd.2017.10.149","article-title":"Does oxygen therapy increase the resolution rate of primary spontaneous pneumothorax?","volume":"9","author":"C.B. 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Chen","year":"2003","journal-title":"Zhonghua Jie He He Hu Xi Za Zhi"},{"issue":"6","key":"pone.0250929.ref029","doi-asserted-by":"crossref","first-page":"2226","DOI":"10.1378\/chest.127.6.2226","article-title":"Video-assisted thoracoscopic surgery for primary spontaneous pneumothorax: evaluation of indications and long-term outcome compared with conservative treatment and open thoracotomy","volume":"127","author":"S. Sawada","year":"2005","journal-title":"Chest"},{"issue":"5","key":"pone.0250929.ref030","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1007\/s00383-013-3273-0","article-title":"Video-assisted thoracoscopic surgery for primary spontaneous pneumothorax in children","volume":"29","author":"S.Y. 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Lawrence","year":"2020","journal-title":"Journal of Pediatric Surgery"},{"issue":"1","key":"pone.0250929.ref037","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/0002-9610(91)90199-N","article-title":"Value of computed tomography of the lung in the management of primary spontaneous pneumothorax","volume":"162","author":"B.W. Warner","year":"1991","journal-title":"The American Journal of Surgery"},{"issue":"6","key":"pone.0250929.ref038","doi-asserted-by":"crossref","first-page":"2368","DOI":"10.1378\/chest.124.6.2368","article-title":"Thoracoscopic Appearance of Bilateral Spontaneous Pneumothorax","volume":"124","author":"M. Tamura","year":"2003","journal-title":"Chest"},{"issue":"2","key":"pone.0250929.ref039","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1378\/chest.118.2.380","article-title":"Can CT Scanning Be Used To Select Patients With Unilateral Primary Spontaneous Pneumothorax for Bilateral Surgery?","volume":"118","author":"A.D.L. Sihoe","year":"2000","journal-title":"Chest"},{"key":"pone.0250929.ref040","first-page":"727","volume-title":"Imaging of diseases of the chest","author":"S. Desai","year":"2000","edition":"3"},{"issue":"1","key":"pone.0250929.ref041","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1055\/s-0039-3402522","article-title":"Management of Spontaneous Pneumothorax in Children: A Systematic Review and Meta-Analysis","volume":"30","author":"M.E. Miscia","year":"2020","journal-title":"Eur J Pediatr Surg"},{"issue":"4","key":"pone.0250929.ref042","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1378\/chest.106.4.992","article-title":"Pleurodesis For Spontaneous Pneumothorax: Will the Procedure of Choice Please Stand Up?","volume":"106","author":"R. Berger","year":"1994","journal-title":"CHEST"},{"issue":"12","key":"pone.0250929.ref043","doi-asserted-by":"crossref","first-page":"2151","DOI":"10.1016\/j.jpedsurg.2008.08.041","article-title":"Video-assisted thoracic surgery for primary spontaneous pneumothorax in children: is there an optimal technique?","volume":"43","author":"R.C. Bialas","year":"2008","journal-title":"J Pediatr Surg"},{"issue":"4","key":"pone.0250929.ref044","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1097\/JCMA.0000000000000073","article-title":"The influence of pleurodesis on the outcome of primary spontaneous pneumothorax in children","volume":"82","author":"I.-C. Chan","year":"2019","journal-title":"Journal of the Chinese Medical Association"},{"issue":"1","key":"pone.0250929.ref045","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1097\/SLE.0b013e31823cc61e","article-title":"Pleural Abrasion for Mechanical Pleurodesis in Surgery for Primary Spontaneous Pneumothorax: Is it Effective?","volume":"22","author":"J.S. Park","year":"2012","journal-title":"Surgical Laparoscopy Endoscopy & Percutaneous Techniques"},{"issue":"3","key":"pone.0250929.ref046","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1016\/S0003-4975(02)04544-7","article-title":"Videothoracoscopic bleb excision and pleural abrasion for the treatment of primary spontaneous pneumothorax: long-term results","volume":"75","author":"L. Lang-Lazdunski","year":"2003","journal-title":"Ann Thorac Surg"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0250929","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,30]],"date-time":"2021-04-30T17:25:27Z","timestamp":1619803527000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0250929"}},"subtitle":[],"editor":[{"given":"Christopher","family":"Cao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,4,30]]},"references-count":46,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4,30]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0250929","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,30]]}}}