Comparative effectiveness of pleural drainage procedures for the treatment of complicated pneumonia in childhood

Samir S Shah, Matthew Hall, Jason G Newland, Thomas V Brogan, Reid W D Farris, Derek J Williams, Gitte Larsen, Bryan R Fine, James E Levin, Jeffrey S Wagener, Patrick H Conway, Angela L Myers
Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine 2011, 6 (5): 256-63

OBJECTIVE: To determine the comparative effectiveness of common pleural drainage procedures for treatment of pneumonia complicated by parapneumonic effusion (ie, complicated pneumonia).

DESIGN: Multicenter retrospective cohort study.

SETTING: Forty children's hospitals contributing data to the Pediatric Health Information System.

PARTICIPANTS: Children with complicated pneumonia requiring pleural drainage.

MAIN EXPOSURES: Initial drainage procedures were categorized as chest tube without fibrinolysis, chest tube with fibrinolysis, video-assisted thoracoscopic surgery (VATS), and thoracotomy.

MAIN OUTCOME MEASURES: Length of stay (LOS), additional drainage procedures, readmission within 14 days of discharge, and hospital costs.

RESULTS: Initial procedures among 3500 patients included chest tube without fibrinolysis (n = 1762), chest tube with fibrinolysis (n = 623), VATS (n = 408), and thoracotomy (n = 797). Median age was 4.1 years. Overall, 716 (20.5%) patients received an additional drainage procedure (range, 6.8-44.8% across individual hospitals). The median LOS was 10 days (range, 7-14 days across individual hospitals). The median readmission rate was 3.8% (range, 0.8%-33.3%). In multivariable analysis, differences in LOS by initial procedure type were not significant. Patients undergoing initial chest tube placement with or without fibrinolysis were more likely to require additional drainage procedures. However, initial chest tube without fibrinolysis was the least costly strategy.

CONCLUSION: There is variability in the treatment and outcomes of children with complicated pneumonia. Outcomes were similar in patients undergoing initial chest tube placement with or without fibrinolysis. Those undergoing VATS received fewer additional drainage procedures but had no differences in LOS compared with other strategies.

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