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Predictive factors of morbidity in childhood parapneumonic effusion-associated pneumonia: a retrospective study
Elie Picard1, Leon Joseph, Shmuel Goldberg
1Department of Pediatric Pulmonology, Shaare Zedek Medical Center, affiliated to the Hebrew University, School of Medicine, Jerusalem, Israel. picard@szmc.org.il
Insights
Predicting prolonged fever in pediatric pneumonia is possible. Positive bacterial cultures and underlying conditions indicate longer fever duration, guiding early treatment decisions for children with parapneumonic effusion.
Area of Science:
- Pediatric infectious diseases
- Pulmonology
- Clinical microbiology
Background:
- Parapneumonic effusion-associated pneumonia is a common pediatric illness.
- Prolonged fever can complicate management and prolong hospital stays.
- Identifying predictors of fever duration is crucial for optimizing treatment strategies.
Purpose of the Study:
- To identify clinical and laboratory criteria that best predict prolonged fever in children with parapneumonic effusion-associated pneumonia.
- To develop a predictive score for prolonged fever duration.
Main Methods:
- Retrospective cohort study of 120 children admitted with empyema and pleurisy.
- Analysis of clinical data, laboratory results, and treatment interventions.
- Development and validation of a fever duration score.
Main Results:
- Positive bacterial cultures (blood or pleural fluid) and a history of underlying disease were significantly associated with prolonged fever.
- Platelet count, pleural fluid pH, and pleural/serum ratios of lactate dehydrogenase (LDH) and glucose weakly correlated with fever duration.
- A fever duration score incorporating platelet count, pleural fluid pH, and pleural/serum LDH and glucose ratios predicted prolonged fever (>7 days) with 91% sensitivity.
Conclusions:
- Positive bacterial cultures and underlying diseases are key indicators of prolonged fever in pediatric parapneumonic effusion.
- A predictive score utilizing platelet count, pleural fluid pH, and pleural/serum LDH/glucose ratios can identify children at risk for prolonged fever.
- Children with identified risk factors may benefit from an early, aggressive treatment approach.
Study Objective:
To find the clinical and laboratory criteria that best predict a prolonged fever in children with parapneumonic effusion-associated pneumonia treated conservatively.
Design:
Retrospective, cohort study.
Patients:
Children admitted to the Shaare Zedek Medical Center between January 1, 1997, and December 31, 2006, and who had been discharged with a diagnosis of empyema and pleurisy.
Measurements And Results:
One hundred-twenty children were included, all of whom were treated with antibiotics; in 80 patients, a thoracic drain was introduced; in 23, pleural tap was performed; and in 17 patients, no special procedure was performed. In no case was video-assisted thoracic surgery performed. The mean total days of fever was 12.8 +/- 5.9 (2-29 days), and the mean length of stay at the hospital was 11.5 +/- 4.9 (3-25) days. In 44 patients (37%), a bacterial culture was positive either in blood or in pleural fluid or both. A positive blood or a positive pleural fluid culture was significantly associated with a prolonged fever as was a history of an underlying disease. Platelet counts, serum Na, serum protein, pleural lactate dehydrogenase (LDH), pleural glucose, pleural/serum LDH ratio, pleural/serum glucose ratio, and pleural fluid pH were the only factors significantly but weakly correlated with the total duration of fever or duration of fever after admission. A "fever duration" score using platelet count, pleural fluid pH, pleural/serum LDH ratio, and pleural/serum glucose ratio predicted a prolonged course of fever (>7 days) with a sensitivity of 91% (95% confidence interval: 60%-100%) and a specificity of 47% (95% confidence interval: 25%-71%).
Conclusions:
In children with parapneumonic effusion-associated pneumonia, a positive bacterial culture and an underlying disease are associated with prolonged fever. A low score based on platelet count, pH pleural fluid and glucose, and LDH pleural/serum ratio is associated with a prolonged fever. We speculate that children with the risk factors mentioned earlier may be the best candidates for an early aggressive approach.
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