Given the paucity of data on pediatric spontaneous pneumomediastinum (SPM), management is largely informed by extrapolation from adult studies or personal clinical experience, resulting in significant heterogeneity. The purpose of this study was to describe how pediatric patients with SPM are clinically managed at our institution and propose a treatment algorithm. Retrospective chart review of pediatric patients with SPM from April 2002 to December 2021 at a single Canadian tertiary care center. Data on medical history, presentation characteristics, clinical management, and complications were gathered. Descriptive and inferential statistics were used to analyze data. We identified 63 patients for inclusion, median age was 15 years. Twenty-nine patients were transferred from another facility. Most common presenting symptoms were chest pain (72.3%), shortness of breath (44.6%), and subcutaneous emphysema (21.5%). Initial workup included chest x-ray (93.6%), CT scan (20.6%), and upper GI series (7.9%). There was no difference in the number of initial tests between admitted and discharged patients (p = 0.10). Of admitted patients ( = 35), 31.4% had primary SPM (no underlying comorbidity/inciting event) and 68.8% were secondary SPM (underlying comorbidity/inciting event). No patients with primary SPM developed complications or recurrences. In contrast, 16.7% of those with secondary SPM developed complications and 54.2% had at least one additional intervention after admission. There is significant variability in diagnostic investigation and treatment of pediatric SPM at our center. Amongst primary SPM, additional tests did not change complication rate or recurrence, including those transferred from another facility. An expeditious treatment algorithm is warranted. Retrospective Cohort Study. III.

中文翻译：

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自发性纵隔气肿儿科患者的管理：回顾性图表回顾

鉴于儿科自发性纵隔气肿 (SPM) 的数据匮乏，治疗主要依靠成人研究或个人临床经验的推断，从而导致显着的异质性。本研究的目的是描述我们机构如何对 SPM 儿科患者进行临床管理，并提出治疗方案。对 2002 年 4 月至 2021 年 12 月在加拿大一家三级护理中心的 SPM 儿科患者进行回顾性图表审查。收集有关病史、表现特征、临床治疗和并发症的数据。使用描述性统计和推论性统计来分析数据。我们确定了 63 名患者纳入，中位年龄为 15 岁。二十九名患者是从另一家机构转来的。最常见的症状是胸痛（72.3%）、气短（44.6%）和皮下气肿（21.5%）。初始检查包括胸部 X 光检查 (93.6%)、CT 扫描 (20.6%) 和上消化道系列 (7.9%)。入院和出院患者之间的初始检查数量没有差异（p = 0.10）。在入院患者 (= 35) 中，31.4% 患有原发性 SPM（无潜在合并症/诱发事件），68.8% 患有继发性 SPM（潜在合并症/诱发事件）。原发性 SPM 患者没有出现并发症或复发。相比之下，16.7% 的继发性 SPM 患者出现并发症，54.2% 的患者入院后至少接受过一项额外干预。我们中心儿科 SPM 的诊断调查和治疗存在显着差异。在初级 SPM 中，额外的测试不会改变并发症发生率或复发率，包括从其他机构转移的测试。需要快速的治疗算法。回顾性队列研究。三．