Primary spontaneous pneumothorax (PSP) occurs in patients without underlying lung disease. There is limited research into the differences in management of PSP in children and adults, it was therefore our aim to compare initial PSP management between these two groups. 

In this single centre study, we prospectively recruited all patients presenting with PSP to our hospital, including both local secondary care and regional tertiary care patients. Between 2014 and 2022, 71 patients, 24 paediatric and 47 young-adults presented to our service, out of a total of 791 pneumothorax referrals. 

The median age (range) of the paediatric group was 15 years (13-15), and 18 years (16-19) for the young-adult group. The male:female ratio was 4.5:1 in children and 15.7:1 among the young adults. For large PSPs (?2cm at the hilum), the proportions receiving conservative management (10% children, 8% young adults), aspiration (45% children, 42% young adults), and ICD (45% children, 50% young adults) were not significantly different (?2 = 0.04. p=0.98). Median length of stay (LOS) in hospital for children was significantly longer compared to young adults (2 days Vs 0 days, p=0.02). Of the conservatively managed patients, 62.5% of paediatric patients received supplemental oxygen, compared to only 4% of young adult patients. 

In conclusion, while the initial treatment of large PSP was similar for children and young adults, the LOS and use of supplemental oxygen was higher for children. With increasing use of outpatient ambulatory care for pneumothoraces in the future, these differences may become more marked and so clinical trials involving paediatric cases are urgently needed.