Lack of concordance in parapneumonic effusion management in children in central Europe.
Treatment of parapneumonic effusion in children remains controversial in the literature and in clinical practice. The aim of this study was to determine whether mutual consensus exists in the diagnosis and treatment of parapneumonic effusion in Central European countries. A questionnaire was sent to all directors of pediatric respiratory units in four adjacent Central European countries (Austria, France, Germany, Switzerland). The response rate was 61.8%. Responses reflected acceptable agreement regarding initial diagnostic procedures, as most centers performed chest X-ray and biological exams, followed by ultrasound, thoracocentesis, or computed tomography. However, antibiotic regimens were very heterogeneous, and the survey revealed complete lack of agreement on the indications and effusion volume threshold for invasive procedures, such as fibrinolytic instillation and thoracoscopy. In conclusion, apart from initial diagnostic procedures, this study showed a lack of mutual consensus among the four countries regarding the management of pediatric parapneumonic effusion. Multicenter prospective trials are clearly needed to acquire more evidence on the management of childhood parapneumonic effusion, enabling the development of evidence-based algorithms that could help to avoid unnecessary examinations with potential long-term side effects, such as radiation exposure at a young age.
Department of Pediatrics, Respiratory Unit, Lausanne University Hospital, Lausanne, Switzerland.
Gaudenz M
GM
Hafen
Department of Pediatric Pulmonology, Clinic for Pediatric and Adolescent Medicine, University of Luebeck, Luebeck, Germany.
Andrea-Claudia
AC
Grenzbach
Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland.
Alexander
A
Moeller
Department of Pediatrics, Lausanne University Hospital, Lausanne, Switzerland.
Mascha K
MK
Rochat
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001317:Austria / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D032921:Consensus; D003937:Diagnosis, Differential; D016724:Empyema, Pleural / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005602:France / Q000453:epidemiology; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D010996:Pleural Effusion / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D011446:Prospective Studies; D013902:Radiography, Thoracic; D018570:Risk Assessment; D013557:Switzerland / Q000453:epidemiology; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents; D005343:Fibrinolytic Agents
child; empyema; pleural effusion; pneumonia