[Application of clinical guidelines in the management of pleural effusion]

To analyze compliance with recommendations on the diagnosis and treatment of pleural effusion (PE), we conducted a retrospective study of 60 consecutive patients with PE. Thirty had been treated on the internal medicine ward (IM) and 30 had been cared for in the pneumology unit (P). Twelve variables were studied: 3 reflected the efficacy of medical intervention and 9 were related to diagnostic and therapeutic procedures as recommended by the American Thoracic Society and the American College of Physicians. PE was generally managed in accordance with the aforementioned guidelines. However, a number of unnecessary analytical tests were performed on pleural liquid from the first thoracocentesis. Although IM patients were comparable to P ward patients as to age, sex and concurrent chronic disease, the mean hospital stay was shorter for P ward patients (16 days versus 18 days in the IM ward, p < 0.05), and the percentage for whom an etiological diagnosis had been achieved upon discharge was higher in the P group (56% of P patients versus 26% of IM patients, p < 0.002). More P group patients than IM patients were followed up after discharge (83% versus 40%, respectively; p < 0.001). There were no significant differences in the remaining variables. Within the limitations of any retrospective study, these results allow us to conclude that PE is generally managed in accordance with international guidelines at our hospital and that diagnostic efficacy is greater on the pneumology ward, where mean stay is shorter.