Related Experiment Video
Updated: Jan 30, 2026
Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion
Published on: November 10, 2023
Time to next procedure in patients with malignant pleural effusion undergoing aspiration: derivation and initial
Eleanor K Mishra1,2, Helen Davies3, Syed Hamza Abbas4,5
1University of East Anglia Faculty of Medicine and Health Sciences, Norwich, UK e.mishra@uea.ac.uk.
Introduction:
In patients with malignant pleural effusions (MPE), pleural fluid reaccumulates at variable rates following therapeutic aspiration. The aim of this study was to identify variables which predict time to next procedure and use them to develop a predictive score.
Methods:
This prospective observational cohort study in 10 British hospitals recruited patients with known or suspected malignant effusions undergoing therapeutic aspiration. Follow-up lasted 3 months and assessed time to next clinically indicated pleural procedure. Regression analysis was performed to identify independent variables predicting time to next procedure, and a score derived. Initial validation was done in two external cohorts.
Measurements And Main Results:
241 patients were recruited. Within the derivation cohort (n=180), baseline respiratory rate (R), pleural effusion depth on ultrasound (E) and dyspnoea measured using a visual analogue scale (D) (combined to form the RED score) were independent predictors of time to next procedure. Predictive models provided areas under the receiver operator curve of 0.73 and 0.75. Initial validity testing in two cohorts (n=31, n=57) demonstrated reasonable predictive value.
Conclusions:
In patients with MPE, baseline respiratory rate, pleural effusion depth on ultrasound and dyspnoea predict time to next procedure.
Trial Registration Number:
ISRCTN16567838.
Insights
Malignant pleural effusions (MPE) often reaccumulate after aspiration. A new RED score, using respiratory rate, effusion depth, and dyspnea, predicts when patients with MPE will need another procedure.
Area of Science:
- Pulmonology
- Oncology
- Medical Statistics
Background:
- Malignant pleural effusions (MPE) frequently reaccumulate after therapeutic aspiration.
- Predicting the time to the next procedure is crucial for managing MPE patients.
- Current methods for predicting reaccumulation rates are limited.
Purpose of the Study:
- To identify variables that predict the time until the next pleural procedure is needed in MPE patients.
- To develop a predictive score for this time interval.
- To validate the predictive score in independent cohorts.
Main Methods:
- A prospective observational cohort study was conducted across 10 British hospitals.
- Patients with known or suspected MPE undergoing therapeutic aspiration were recruited.
- Regression analysis identified predictors, and a RED score (Respiratory rate, Effusion depth, Dyspnoea) was derived and validated.
Main Results:
- The study recruited 241 patients (180 in the derivation cohort).
- Baseline respiratory rate, ultrasound-measured pleural effusion depth, and visual analogue scale dyspnea score independently predicted time to the next procedure.
- The RED score demonstrated good predictive value with areas under the receiver operator curve of 0.73 and 0.75.
Conclusions:
- Respiratory rate, pleural effusion depth, and dyspnea are key predictors of time to the next procedure in MPE patients.
- The derived RED score offers a validated tool for predicting the need for subsequent pleural interventions.
- This score can aid in clinical decision-making and patient management for MPE.
Related Concept Videos
01:25Pleural Effusion I: Introduction
There are two main types of pleural effusion: transudative and exudative. They are differentiated using Light's...
01:28Pleural Effusion II: Symptoms and Management
A pleural effusion is the abnormal collection of fluid between the parietal and visceral pleura layers of tissue that form the lining of the lungs and chest cavity. It can occur independently or due to surrounding parenchymal diseases, such as infection, malignancy, or inflammatory conditions.
Clinical Manifestations:
01:19Handwashing II: Pre-procedure and Initial Procedure Steps
The hand washing procedure itself includes the following steps. First, cover cuts, if any, on hands with a waterproof dressing. Cuts and abrasions can become contaminated with bacteria hindering the ability to clean the area thoroughly. In addition, repeated hand washing can worsen an injury. The nails must be short and clean, without nail...
03:48Behavior of Gas Molecules: Molecular Diffusion, Mean Free Path, and Effusion
01:29Reliability and Validity
02:33Initiation of Translation
First, the initiator tRNA must be selected from the pool of elongator tRNAs by eukaryotic initiation factor 2 (eIF2). The initiator tRNA (Met-tRNAi) has conserved sequence elements including modified bases at...