Outcomes of primary image-guided drainage of parapneumonic effusions in children.
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.
Division of Cardiovascular and Interventional Radiology, Department of Radiology, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Ragheed K
RK
Mitri
Stephen D
SD
Brown
David
D
Zurakowski
Kee Y
KY
Chung
Orhan
O
Konez
Patricia E
PE
Burrows
Andrew A
AA
Colin
D000293:Adolescent; D002404:Catheterization; D002648:Child; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D009339:Needles; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography