Factors Affecting the Length of Hospital Stay in Patients with Parapneumonic Effusion Undergoing Conservative Treatment

Öz

Introduction: Parapneumonic effusion (PPE) is a common complication of community-acquired pneumonia in children, often requiring hospitalization and varying treatment approaches. This study aimed to identify the factors influencing the length of hospital stay in pediatric patients with PPE managed conservatively.

Methods: This retrospective cross-sectional study analyzed pediatric patients diagnosed with PPE and hospitalized between January 1, 2017, and December 31, 2021. Clinical, laboratory, radiological, and treatment data were reviewed to evaluate the factors associated with the length of hospital stay in conservatively managed cases.

Results: The study included 90 patients, with a median age of 6.7 years; 55.6% were female and 64.4% were older than 5 years. The most common symptoms were cough (87.8%) and fever (83.3%), and the median length of hospital stay (LOS) was 21 days. Patients under 5 years of age, those requiring respiratory support, and those needing a change in antibiotic therapy (ABT) had significantly longer LOS. LOS was shorter in patients receiving ABT alone compared with those who also underwent chest tube drainage, and early fibrinolytic treatment (within the first week) was associated with shorter LOS compared with delayed (>2 weeks) administration.

Conclusions: Early chest tube drainage, especially in children under five years of age, may help reduce the LOS in conservatively managed PPE cases. Prospective studies are needed to confirm these findings and support clinical decision-making in pediatric PPE management.

Anahtar Kelimeler

• Parapneumonic effusion
• Children
• Treatment

Kaynakça

1. Cashen K, Petersen TL. Pleural Effusions and Pneumothoraces. Pediatr Rev. 2017 Apr;38(4):170-181. doi: 10.1542/pir.2016-0088. Erratum in: Pediatr Rev. 2017 Jun;38(6):291. doi: 10.1542/pir.386291. PMID: 28364048. google scholar
2. Hendaus MA, Janahi IA. Parapneumonic Effusion in Children: An Up-to-Date Review. Clin Pediatr (Phila). 2016 Jan;55(1):10-8. doi: 10.1177/0009922815589917. Epub 2015 Jun 7. PMID: 26054782. google scholar
3. Kocabaş, E., Ersöz, D. D., Karakoç, F., Tanır, G., Cengiz, A. B., Gür, D, et al. (2009). Türk Toraks Derneği çocuklarda toplumda gelişen pnömoni tanı ve tedavi uzlaşı raporu. Türk Toraks Dergisi, 10(3), 1-26. google scholar
4. Yilmaz, E., Doğan, Y., Aydinoğlu, A. H., Gürgöze, M. K., & Aygün, D. (2002). Parapneumonic empyema in children: conservative approach. The Turkish Journal of Pediatrics, 44(2), 134-138. google scholar
5. Bradley, John S. "Management of community-acquired pediatric pneumonia in an era of increasing antibiotic resistance and conjugate vaccines." The Pediatric infectious disease journal 21.6 (2002): 592-598. google scholar
6. Florin, T. A., Brokamp, C., Mantyla, R., DePaoli, B., Ruddy, R., Shah, S. S., et al. (2018). Validation of the pediatric infectious diseases society–infectious diseases society of america severity criteria in children with community-acquired pneumonia. Clinical Infectious Diseases, 67(1), 112-119. google scholar
7. Keren, R., Luan, X., Localio, R., Hall, M., McLeod, L., Dai, D., et al. (2012). Prioritization of comparative effectiveness research topics in hospital pediatrics. Archives of pediatrics & adolescent medicine, 166(12), 1155-1164. google scholar
8. Harris, M., Clark, J., Coote, N., Fletcher, P., Harnden, A., McKean, M., et al. (2011). British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax, 66(Suppl 2), ii1-ii23. google scholar

9. Byington, C. L., Spencer, L. Y., Johnson, T. A., Pavia, A. T., Allen, D., Mason, E. O., et al. (2002). An epidemiological investigation of a sustained high rate of pediatric parapneumonic empyema: risk factors and microbiological associations. Clinical Infectious Diseases, 34(4), 434-440. google scholar
10. Çiftçi, E., Bingöl, E. B., İnce, E., & Doğru, Ü. Çocuklarda plevral ampiyem: 35 hastanın değerlendirilmesi Orijinal Araştırma. Türk Pediatri Arşivi, 39(1). google scholar
11. Langley, J. M., Kellner, J. D., Solomon, N., Robinson, J. L., Le Saux, N., McDonald, J., et al. (2008). Empyema associated with community-acquired pneumonia: a Pediatric Investigator's Collaborative Network on Infections in Canada (PICNIC) study. BMC Infectious Diseases, 8(1), 129. google scholar
12. Shen, K. R., Bribriesco, A., Crabtree, T., Denlinger, C., Eby, J., Eiken, P., et al. (2017). The American Association for Thoracic Surgery consensus guidelines for the management of empyema. The Journal of thoracic and cardiovascular surgery, 153(6), e129-e146. google scholar
13. Hanson, S. J., Havens, P. L., Simpson, P. M., Nugent, M. L., & Wells, R. G. (2015). Intrapleural alteplase decreases parapneumonic effusion volume in children more than saline irrigation. Pediatric Pulmonology, 50(12), 1328-1335. google scholar
14. Misthos, P., Sepsas, E., Konstantinou, M., Athanassiadi, K., Skottis, I., & Lioulias, A. (2005). Early use of intrapleural fibrinolytics in the management of postpneumonic empyema. A prospective study. European journal of cardio-thoracic surgery, 28(4), 599-603. google scholar
15. Rahman, N. M., Maskell, N. A., West, A., Teoh, R., Arnold, A., Mackinlay, C., et al. (2011). Intrapleural use of tissue plasminogen activator and DNase in pleural infection. New England Journal of Medicine, 365(6), 518-526. google scholar
16. Yeğit, C. Y., Aldemir, E. Y., Kaba, Ö., Eres, M., Kılınç, M. A., Deniz, M., et al. (2024). Parapnömonik efüzyonu olan çocuklarda klinik değerlendirme ve hastane yatış süresine etki eden faktörlerin değerlendirilmesi. Umraniye Pediatri Dergisi, 4(3), 102. google scholar
17. Segerer, F. J., Seeger, K., Maier, A., Hagemann, C., Schoen, C., van der Linden, M., et al. German nationwide surveillance study. Pediatric pulmonology, 52(4), 540-547. google scholar
18. Hafen, G. M., Grenzbach, A. C., Moeller, A., & Rochat, M. K. (2016). Lack of concordance in parapneumonic effusion management in children in central Europe. Pediatric pulmonology, 51(4), 411-417. google scholar