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PEDIATRICS Vol. 110 No. 3 September 2002, pp. e37

ELECTRONIC ARTICLE

Outcomes of Primary Image-Guided Drainage of Parapneumonic Effusions in Children

Ragheed K. Mitri, BS*, Stephen D. Brown, MD*, David Zurakowski, PhD{ddagger}, Kee Y. Chung, MD*, Orhan Konez, MD*, Patricia E. Burrows, MD* and Andrew A. Colin, MD§

* Division of Cardiovascular and Interventional Radiology, Department of Radiology
{ddagger} Departments of Orthopaedic Surgery and Biostatistics
§ Division of Respiratory Diseases, Department of Medicine, Children’s Hospital, Harvard Medical School, Boston, Massachusetts

--> Objective. To assess the outcome of image-guided needle aspiration when compared with image-guided percutaneous catheter drainage in the management of parapneumonic effusions in children.

Methods. A retrospective chart review was conducted of the medical records, microbiology, and radiology reports of 67 children who presented with parapneumonic effusions and underwent primary image-guided drainage between April 1, 1995, and April 1, 2000.

Results. Thirty-four patients had aspiration only, and 33 patients had pigtail catheters placed. The 2 drainage methods had similar median length of stay and complication rates. The reintervention rate in this study was 27% (18 patients). Children who underwent primary aspiration without catheter placement had significantly higher rates of reintervention. Method of drainage, pH lower than 7.2, and loculation of the fluid collection were independent predictors of reintervention. A low glucose level was an additive predictor of reintervention when the pH was low.

Conclusions. Aspiration and catheter drainage of parapneumonic effusions had similar complication rates and lengths of stay, but children who underwent primary aspiration had significantly higher reintervention rates, particularly when pH and glucose levels were low. Therefore, primary catheter placement for parapneumonic effusions should be considered in children who undergo diagnostic thoracentesis. The decision regarding tube placement could be facilitated by the on-site availability of a pH meter and a glucometer.

Key Words: pneumonia • pleural effusions • parapneumonic effusion • drainage • thoracentesis • simple aspiration • percutaneous catheter drainage

Abbreviations: VATS, video assisted thoracoscopic surgery • LDH, lactate dehydrogenase • WBC, white blood cell • OR, odds ratio • CI, confidence interval.

Received for publication Oct 16, 2001; Accepted May 22, 2002.


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