IMPLICATIONS OF EARLY SONOGRAPHIC EVALUATION OF PARAPNEUMONIC EFFUSIONS IN CHILDREN WITH PNEUMONIA

Objective. To devise a clinically relevant grading system for the sono graphic evaluation of parapneumonic effusions, and to evaluate length of hospital stay as a function of treatment approach and sonographic g rades. Methods. Chest sonograms of 46 pediatric patients diagnosed wit h empyemas and admitted to two medical centers in the last 8 years wer e retrospectively evaluated using a grading system based on the degree of fibrinous organization within the parapneumonic effusions. Hospita l charts were reviewed to determine the method of treatment and length of hospital stay. Patients were divided into two treatment,groups: no noperative (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 nonopera tive group were further subdivided into two groups: those who received antibiotics alone (n = II) and those who received antibiotics plus no noperative drainage thoracentesis and/or tribe thoracostomy (n = 15). Within each treatment group, patients were subdivided into two ultraso und grades: low (no evidence of organization) and high (evidence of or ganization such as fronds, septations, or loculations). Student's t te st was performed to compare the lengths of hospital stay for each of t he treatment groups and ultrasound grades. Results. The length of hosp italization was no different for patients with low-grade ultrasounds i n the nonoperative (9.8 days) and operative groups (8.0 days). In cont rast, length of hospitalization was significantly shorter for patients with high-grade sonograms in the operative group (8.6 days), when com pared with the nonoperative group (16.4 days). Length of hospitalizati on for patients in the nonoperative group with high-grade sonograms wa s significantly longer (16.4 days) than for those with low-grade ultra sounds (9.8 days). Furthermore, when the nonoperative patients were di vided into an antibiotics alone group and a nonoperative drainage grou p, the patients with low-grade sonograms had no difference in the leng th of hospitalization (9.0 days vs. 10.4 days), whereas those patients with high-grade sonograms in the nonoperative drainage group had a si gnificantly longer hospitalization (19.9 days) than the antibiotics al one (high-grade) group (11.4 days). Conclusions. Patients with a low-g rade sonogram had similar length of hospitalization if treated with ei ther nonoperative or operative measures. Patients with high-grade sono grams had significantly shorter length of hospitalization when treated with decortication. Our retrospective study suggests that patients wi th 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 ol: parapn eumonic effusions. A prospective study evaluating the usefulness of so nographic assessment of severity of disease in the treatment of childr en with parapneumonic effusions is warranted on the basis of our retro spective data.