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

Creator(s)

Samir S. Shah, University of Pennsylvania Perelman School of Medicine
Matthew Hall, Child Health Corporation of America
Jason G. Newland, Children's Mercy Hospital
Thomas V. Brogan, University of Washington School of Medicine
Reid W.D. Farris, University of Washington School of Medicine
Derek J. Williams, Monroe Carell Jr. Children's Hospital at Vanderbilt
Gitte Larsen, The University of Utah
Bryan R. Fine, Children's Hospital of The King's Daughters Health System
James E. Levin, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh
Jeffrey S. Wagener, University of Colorado School of Medicine
Patrick H. Conway, Cincinnati Children's Hospital Medical Center
Angela L. Myers, Children's Mercy Hospital

Document Type

Article

Publication Date

5-2011

Identifier

DOI: 10.1002/jhm.872; PMCID: PMC3112472

Abstract

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.

© 2011 Society of Hospital Medicine.

Journal Title

Journal of Hospital Medicine

Volume

6

Issue

5

First Page

256

Last Page

263

Keywords

Comparative effectiveness research; Epidemiology; Pleural empyema; Pneumonia; Thoracostomy

Comments

Grant support

• K01 AI073729/AI/NIAID NIH HHS/United States
• K01 AI073729-03/AI/NIAID NIH HHS/United States
• K01 AI73729/AI/NIAID NIH HHS/United States

Recommended Citation

Shah, S. S., Hall, M., Newland, J. G., Brogan, T. V., Farris, R. W., Williams, D. J., Larsen, G., Fine, B. R., Levin, J. E., Wagener, J. S., Conway, P. H., Myers, A. L. Comparative effectiveness of pleural drainage procedures for the treatment of complicated pneumonia in childhood Journal of Hospital Medicine 6, 256-263 (2011).