Proposal of a new tool for paediatric primary spontaneous pneumothorax: the Spontaneous Pneumothorax in Adolescents and Children Evaluation (SPACE) score.

BACKGROUND AND AIMS: Primary Spontaneous Pneumothorax (PSP) in paediatric patients is often managed according to adult guidelines, which may be inappropriate due to anatomical and physiological differences between adults and children. No management score has ever been developed for paediatric PSP. The aim of the study was to present the Spontaneous Pneumothorax in Adolescents and Children Evaluation (SPACE) score, a clinical scoring system designed to enhance decision-making in the paediatric PSP management. METHODS: This bicentric retrospective study was conducted across two tertiary paediatric surgery centres, including 53 paediatric patients diagnosed with their first PSP episode (Period: January 2012-January 2025). This study evaluated clinical and radiological factors influencing treatment decisions and employed statistical analyses to develop and validate the SPACE Score. The exclusion criteria encompassed inadequate data, loss to follow-up, and age exceeding 18 at the time of diagnosis. RESULTS: Significant differences in PSP dimensions and clinical outcomes were observed between conservative (n = 35) and drainage (n = 18) treatment groups. The SPACE score demonstrated excellent predictive accuracy in distinguishing treatment needs, with area under the receiver operating characteristic curve values for all models exceeding 0.90. The presence of mediastinal shift and pneumothorax dimensions were identified as critical predictors of the need for drainage. CONCLUSIONS: The SPACE score is a potential tool for improving paediatric PSP management, providing a standardized approach to treatment decisions. However, further research is needed to improve its applicability across clinical settings.