Conservative Treatment of Parapneumonic Effusion in Children: Experience From a 10-Year Consecutive Case Series

Abstract

Background: In children with parapneumonic effusion (PPE), it remains unclear when conservative treatment with antibiotics suffixes or when pleural drainage is needed. In this study we evaluate clinical features and outcomes of children with PPE. Methods: A retrospective, multicentre cohort study at 4 Dutch pediatric departments was performed, including patients 1–18 years treated for PPE between January 2010 and June 2020. Results: One hundred thirty-six patients were included (mean age 8.3 years, SD 4.8). 117 patients (86%) were treated conservatively and 19 (14%) underwent pleural drainage. Patients undergoing pleural drainage had mediastinal shift more frequently compared with conservatively treated patients (58 vs. 3%, difference 55%; 95% CI: 32%–77%). The same accounted for pleural septations/pockets (58 vs. 11%, difference 47%; 95% CI: 24%–70%), pleural thickening (47 vs. 4%, difference 43%; 95% CI: 20%–66%) and effusion size (median 5.9 vs. 2.7 cm; P = 0.032). Conservative management was successful in 27% of patients (4 of 15) with mediastinal shift, 54% of patients (13 of 24) with septations/pockets, 36% of patients (5 of 14) with pleural thickening, and 9% of patients (3 of 32) with effusions >3 cm, all radiological signs generally warranting pleural drainage. In patients treated conservatively, median duration of hospitalization was 5 days (IQR 4–112) compared with 19 days (IQR 15–24) in the drainage group (P < 0.001), without significant difference in readmission rate (11 vs. 4%, difference 6%; 95% CI: –8%–21%). Conclusion: This study suggests that the greater amount of children with PPE could be treated conservatively with antibiotics only, especially in absence of mediastinal shift, pleural septations/pockets, pleural thickening or extensive effusions.