SESSION TITLE: Wednesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE: Primary Spontaneous Pneumothorax (PSP) management in pediatric patients differs widely between medical centers and specialties. Disagreement regarding the optimal initial management of PSP still exists. To improve management of PSP in pediatric patients, this study assessed which initial management method leads to less recurrences and evaluated the significance of each recurrence. METHODS: Medical records at a tertiary-care, community hospital, were analyzed for patients RESULTS: 54 patients ages 12-18 treated for PSP had an average follow-up period of 6.1 years. Of the total, 19%, 24%, and 57% underwent MO, CTP, and SI, respectively. PSP treated by MO were smaller in size, but blebs were more prevalent in the SI group. Recurrence rate was significantly lower for SI, 17%, compared to MO and CTP groups, 60%, 42 %, respectively (p=0.025). In patients who recurred after initial MO or CTP treatment for PSP, 67% and 100% required an invasive intervention (CTP or SI respectively) at initial recurrence. The most common management at time of initial recurrence was surgery. CONCLUSIONS: Disagreement and a paucity in the literature exists regarding the best initial management of PSP, especially in pediatrics. These results are one of the largest studies of its kind and has the longest follow-up period to address this issue. Results demonstrate a 3-4x lower recurrence rate following SI compared to MO or CTP. The majority of recurrences that were initially managed by MO or CTP required invasive intervention at time of recurrence. These findings support early surgical consultation and SI for PSP in the pediatric population. CLINICAL IMPLICATIONS: Great variability in PSP management between both practitioners and institutions exists. Some have elected for MO of most PSPs, while others elect for SI at initial presentation. This is one of the largest studies of its kind to assess the outcomes of these management plans. Results demonstrate a nearly 3-4x lower recurrence rate when a patient underwent SI. Some have suggested that higher recurrence rates in the MO and CTP groups are not significant, as these recurrences do not require SI. This study found in fact the majority of recurrences underwent SI and 67-100% of recurrences required invasive management. These findings can provide clinicians data that can be utilized in the creation of treatment algorithms for the management of PSP in the pediatric population. DISCLOSURES: No relevant relationships by Devon Collins, source=Web Response No relevant relationships by Sameer Javed, source=Web Response Consultant relationship with Medtronic Please note: $20001 - $100000 Added 03/14/2019 by Sandeep Khandhar, source=Web Response, value=Consulting fee Consultant relationship with Auris Robotics Please note: $5001 - $20000 Added 03/14/2019 by Sandeep Khandhar, source=Web Response, value=Consulting fee Advisory Committee Member relationship with Boston Scientific Please note: $1001 - $5000 Added 03/14/2019 by Sandeep Khandhar, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with Bard Please note: $1001 - $5000 Added 03/14/2019 by Sandeep Khandhar, source=Web Response, value=Consulting fee Stock Holder relationship with Transenterix Please note: $5001 - $20000 Added 03/14/2019 by Sandeep Khandhar, source=Web Response, value=Stock Consultant relationship with Medtronic Please note: $1001 - $5000 Added 03/14/2019 by Sandeep Khandhar, source=Web Response, value=Travel Board Member relationship with bh Please note: $1-$1000 Added 03/14/2019 by Sandeep Khandhar, source=Web Response, value=Consulting fee Removed 03/14/2019 by Sandeep Khandhar, source=Web Response No relevant relationships by Chang Liu, source=Admin input Consultant relationship with Medtronic Corporation Please note: $20001 - $100000 Added 10/20/2018 by Amit Mahajan, source=Web Response, value=Consulting fee Consultant relationship with Auris Robotics Please note: $5001 - $20000 Added 10/20/2018 by Amit Mahajan, source=Web Response, value=Consulting fee Consultant relationship with Boston Scientific Please note: $1001 - $5000 Added 10/20/2018 by Amit Mahajan, source=Web Response, value=Consulting fee Advisory Committee Member relationship with Biodesix Please note: $5001 - $20000 Added 10/20/2018 by Amit Mahajan, source=Web Response, value=Consulting fee No relevant relationships by Jay Patel, source=Web Response No relevant relationships by Josh Stodghill, source=Web Response