PEDIATRICS Vol. 101 No. 1 January 1998, pp. 68-71
Implications of Early Sonographic Evaluation of Parapneumonic Effusions in Children With Pneumonia
Received Mar 27, 1997; accepted Jun 20, 1997.
,
,
From the Departments of * Radiology, Pulmonary Medicine and
¶ Surgery, Vanderbilt Children's Hospital, Nashville, Tennessee; and
the Departments of Radiology and § Pediatrics, University of Chicago
Children's Hospital, Chicago, Illinois.
Objective. To devise a clinically relevant grading system for the sonographic evaluation of parapneumonic effusions, and to evaluate length of hospital stay as a function of treatment approach and sonographic grades.
Methods. Chest sonograms of 46 pediatric patients diagnosed with empyemas and admitted to two medical centers in the last 8 years were retrospectively evaluated using a grading system based on the degree of fibrinous organization within the parapneumonic effusions. Hospital charts were reviewed to determine the method of treatment and length of hospital stay. Patients were divided into two treatment groups: nonoperative (n = 26) (antibiotics alone, or combined with thoracentesis, or tube thoracostomy) and operative (n = 20) (open decortication, or video thoracoscopy and pleural debridement). Patients in the nonoperative group were further subdivided into two groups: those who received antibiotics alone (n = 11) and those who received antibiotics plus nonoperative drainage thoracentesis and/or tube thoracostomy (n = 15). Within each treatment group, patients were subdivided into two ultrasound grades: low (no evidence of organization) and high (evidence of organization such as fronds, septations, or loculations). Student's t test was performed to compare the lengths of hospital stay for each of the treatment groups and ultrasound grades.
Results. The length of hospitalization was no different for patients with low-grade ultrasounds in the nonoperative (9.8 days) and operative groups (8.0 days). In contrast, length of hospitalization was significantly shorter for patients with high-grade sonograms in the operative group (8.6 days), when compared with the nonoperative group (16.4 days). Length of hospitalization for patients in the nonoperative group with high-grade sonograms was significantly longer (16.4 days) than for those with low-grade ultrasounds (9.8 days). Furthermore, when the nonoperative patients were divided into an antibiotics alone group and a nonoperative drainage group, the patients with low-grade sonograms had no difference in the length of hospitalization (9.0 days vs. 10.4 days), whereas those patients with high-grade sonograms in the nonoperative drainage group had a significantly longer hospitalization (19.9 days) than the antibiotics alone (high-grade) group (11.4 days).
Conclusions. Patients with a low-grade sonogram had similar length of hospitalization if treated with either nonoperative or operative measures. Patients with high-grade sonograms had significantly shorter length of hospitalization when treated with decortication. Our retrospective study suggests that patients with high-grade ultrasound studies treated nonoperatively do not benefit from pleural drainage procedures or chest tube placement. This study demonstrates the usefulness of early sonographic evaluation of parapneumonic effusions. A prospective study evaluating the usefulness of sonographic assessment of severity of disease in the treatment of children with parapneumonic effusions is warranted on the basis of our retrospective data.
Key words: empyema, parapneumonic effusion, ultrasound, pneumonia.
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  J. Kurian, T. L. Levin, B. K. Han, B. H. Taragin, and S. Weinstein Comparison of Ultrasound and CT in the Evaluation of Pneumonia Complicated by Parapneumonic Effusion in Children Am. J. Roentgenol., December 1, 2009; 193(6): 1648 - 1654. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. S. Shah, C. M. DiCristina, L. M. Bell, T. Ten Have, and J. P. Metlay Primary Early Thoracoscopy and Reduction in Length of Hospital Stay and Additional Procedures Among Children With Complicated Pneumonia: Results of a Multicenter Retrospective Cohort Study Arch Pediatr Adolesc Med, July 1, 2008; 162(7): 675 - 681. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O. Dikensoy and R. W. Light Diagnosing Empyema in Children Am. J. Respir. Crit. Care Med., January 1, 2007; 175(1): 94a - 95. [Full Text] [PDF]
|
|
|
|
 |
|
 B. A. Kurt, K. M. Winterhalter, R. H. Connors, B. W. Betz, and J. W. Winters Therapy of Parapneumonic Effusions in Children: Video-Assisted Thoracoscopic Surgery Versus Conventional Thoracostomy Drainage Pediatrics, September 1, 2006; 118(3): e547 - e553. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Mattei and J. L. Allen Treatment of Empyema in Children: From Hippocrates' Time to the Present, and Back Again Am. J. Respir. Crit. Care Med., July 15, 2006; 174(2): 110 - 111. [Full Text] [PDF]
|
|
|
|
 |
|
 C. Alexiou, A. Goyal, R. K. Firmin, and M. St. J. Hickey Is open thoracotomy still a good treatment option for the management of empyema in children? Ann. Thorac. Surg., December 1, 2003; 76(6): 1854 - 1858. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O. Efrati and A. Barak Pleural Effusions in the Pediatric Population Pediatr. Rev., December 1, 2002; 23(12): 417 - 426. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Beckh, P. L. Bolcskei, and K.-D. Lessnau Real-Time Chest Ultrasonography: A Comprehensive Review for the Pulmonologist Chest, November 1, 2002; 122(5): 1759 - 1773. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Gaston Pneumonia Pediatr. Rev., April 1, 2002; 23(4): 132 - 140. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. King and A. Thomson Radiological perspectives in empyema: Childhood respiratory infections Br. Med. Bull., March 1, 2002; 61(1): 203 - 214. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Shoseyov, H. Bibi, G. Shatzberg, A. Klar, J. Akerman, H. Hurvitz, and C. Maayan Short-term Course and Outcome of Treatments of Pleural Empyema in Pediatric Patients : Repeated Ultrasound-Guided Needle Thoracocentesis vs Chest Tube Drainage Chest, March 1, 2002; 121(3): 836 - 840. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. R. Bye;, J. L. Colombo;, R. M. Heller, and M. Hernanz-Schulman Pleural Effusions Pediatrics, October 1, 1998; 102(4): 999 - 1000. [Full Text] [PDF]
|
|
