Decision-Making Criteria for Observational Management of Congenital Pulmonary Airway Malformations (CPAMs)

作者：Robinson Ashley; Romao Rodrigo; Mills Jessica; Davies Dafydd A^*

来源：Journal of Pediatric Surgery, 2018, 53(5): 1006-1009.

DOI：10.1016/j.jpedsurg.2018.02.035

• Congenital pulmonary airway malformations
• CPAM
• Observational management

Purpose: The purpose of this studywas to determine practice patterns of Canadian surgeonsmanaging congenital pulmonary airway malformations (CPAMs) and factors influencing practice.
Methods: Pediatric surgeons in Canada were surveyed regarding their experience, evaluation, and management CPAMs, and what factors they feel qualify patients for observation vs resection. Data were summarized, and Fisher's-Exact and Kruskal-Wallis Tests applied where appropriate.
Results: Sixty eight percent (n = 46) of surgeons responded. However, three surveys were incomplete and excluded. The median age of initial assessment by a pediatric surgeon was onemonth. 98% (42/43) use CXR for initial imaging, and 83% (36/43) recommend CT scan for further evaluation. Observation is offered always, almost always, or sometimes by 2%, 35% and 37%, respectively. Only 16% almost never, and 9% never offer it. Years in practice was not associated with this decision (p = 0.41). Of surgeons who offer observation, 78% (28/37) use morphology to guide their decision, and 63% (21/37) use lesion size (<1 cmto <5cms). 68%(23/37) consider the number of lesions, and 61%(14/23) of those only offer observation to solitary lesions.
Conclusion: Most pediatric surgeons in Canada offer observational management to patients with asymptomatic CPAMs. While practice variations exist, detailed imaging with a CT scan early in life to determine the morphology, size, and number of lesions guides practice.

• 出版日期2018-5