title: Survey of hospital procedures for parapneumonic effusion in children highlights need for standardised management.
abstract: OBJECTIVE
  This study sought to evaluate the initial management of children with parapneumonic effusion admitted to all French university hospitals.
  
  
  METHODS
  A nationwide survey of all 35 university hospitals took place in 2011 to assess practices for children with parapneumonic effusion, using a hypothetical clinical vignette and a standardised questionnaire. Two to four paediatricians per hospital were interviewed and asked about their initial management, probabilistic antibiotic therapy and its adaptation to microbiological results and subsequent course. Answers from paediatricians working in emergency departments, intensive care units and conventional paediatric units were compared.
  
  
  RESULTS
  Of the 100 paediatricians contacted, 95 responded. Of these, 98% would order an initial blood test, 70% would order diagnostic thoracentesis, and all would start immediate antibiotic therapy: 31% with a single drug, 67% with two drugs and 2% with three drugs. The most frequent initial choices were third-generation cephalosporin alone (17%) or combined with rifampicin (34%) or vancomycin (24%). Adaptation varied according to drug used, dose and duration, especially when the microorganism was not Streptococcus pneumoniae. Practices did not differ significantly among the different groups of paediatricians.
  
  
  CONCLUSIONS
  Standardised management of parapneumonic effusion, including routine thoracentesis and more consistent prescription of antibiotics, is needed.
authors.affiliation: Pediatric Pulmonology Unit, Jeanne de Flandre Hospital, CHRU Lille, Lille, France.
authors.forename: A
authors.initials: A
authors.lastname: Le Mée
authors.forename: C
authors.initials: C
authors.lastname: Mordacq
authors.forename: M
authors.initials: M
authors.lastname: Lagrée
authors.forename: A
authors.initials: A
authors.lastname: Deschildre
authors.forename: A
authors.initials: A
authors.lastname: Martinot
authors.forename: F
authors.initials: F
authors.lastname: Dubos
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D005260:Female; D019538:Health Care Surveys; D006301:Health Services Needs and Demand; D006785:Hospitals, University; D006801:Humans; D008297:Male; D010346:Patient Care Management / Q000592:standards; D010372:Pediatrics; D010996:Pleural Effusion / Q000188:drug therapy* / Q000382:microbiology; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic therapy; Children; Evaluation; Management; Parapneumonic effusion