Abstract

Objective: Pleural effusion is a serious cause of morbidity and mortality in childhood. In this study, it was aimed to investigate the follow-up and treatment of patients by performing etiological classification of children with hospitalization with pleural effusion diagnosis.

Material and Methods: Pediatric patients who were admitted to the Pediatric Services and Intensive Care Unit of Health Sciences University Ankara Child Health and Diseases Hematology Oncology Education and Research Hospital between January 2012 and December 2017 were evaluated. In this retrospective descriptive study, 135 patients aged 0-18 years were examined. The demographic characteristics, clinical features, physical examination findings, underlying additional disease, laboratory data, imaging methods, follow-up and treatment methods of the patients were examined.


Results: 74 (54.8%) of 135 patients diagnosed with pleural effusion were male and the mean age was 8.4±5.3. 78 of the patients (57.8%) were diagnosed with parapneumonic effusion, 14 (10.4%) sepsis, 10 (7.4%) rheumatological disease. The most common presenting symptoms were fever (62.2%), cough (45.9%) and shortness of breath (32.6%). The most common finding on physical examination was tachypnea (39.3%). More than half of the patients (59.2%) had chronic disease. Among these diseases, the most common neurological diseases were found. Thoracentesis was performed in 94 (74%) of 127 patients whose data could be accessed; chest tube was inserted in 70 of them (55.5%). Of the patients diagnosed with parapneumonic effusion, 42 (53.8%) were diagnosed with simple parapneumonic effusion and 36 (46.2%) were diagnosed with complicated parapneumonic effusion (empyema). The most commonly isolated agent was Streptococcus pneumoniae. Fibrinolytic therapy was the most preferred treatment for empyema. Detection of ‘pH ≤ 7,1’ and ‘LDH ≥ 1000’ in pleural fluid was found to be significant in patients with empyema compared to patients with simple parapneumonic effusion, respectively (p:0.003) (p:0.001). Considering the distribution of parapneumonic effusions over the years, there has been an increase in the frequency of empyema in recent years. It was observed that vaccination with pneumococcal vaccine did not make any difference in the development of simple parapneumonic effusion and empyema (p: 0.351).

Conclusion: Parapneumonic effusion was detected in more than half of the pediatric patients who were hospitalized for pleural effusion. Empyema incidence has increased in the last three years. This suggests the presence of invasive strains which cannot be prevented by vaccination. Further studies are needed for diagnosis and treatment in early stage.

Keywords: Empyema, Parapneumonic, Pediatric, Pleural effusion

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1.
Kaplan G, Yakut Hİ, Cinel G. A Retrospective Analysis; Etiological Evaluation of Pleural Effusion in Children, Clinical Presentation and Managemet. Turk J Pediatr Dis [Internet]. 2022 Jan. 28 [cited 2025 May 25];16(1):37-41. Available from: https://turkjpediatrdis.org/article/view/916