Outcome of tube thoracostomy in paediatric non-traumatic pleural fluid collections

Abstract

Objective: Management of pleural fluid collection not due to trauma  increases workload of the paediatric thoracic surgeons, while delay or inappropriate treatment worsens the prognosis of the disease. This study aimed at assessing the outcome of therapeutic tube thoracostomy in non-traumatic paediatric pleural fluid collections and identifying factors responsible for treatment failure with tube thoracostomy.

Design: Prospective analysis of socio-demographic characteristics, clinical
features, clinical diagnosis, radiological diagnosis, and bacteriological diagnosis including bacteria cultured with sensitivity pattern, also treatment offered including tube thoracostomy with duration of tube thoracostomy and length of hospitalisation, indication for additional  surgical procedure with type, and outcome of treatment of 30 paediatric patients with  non-traumatic pleural fluid collection.

Results: Thirty paediatric patients with various causes of non-traumatic pleural fluid collection in 34 pleural spaces were analysed. Their ages ranged between six months and 16 years (mean= 6.5 years) and M:F ratio of 2:1. Pleural effusion and empyema thoracis accounted for 46% and 40% with staphylococcus aureus and streptococcus pneumoniae cultured in 10% each and a high negative culture rate of 46%, which was higher with age. The parents of 40% of the patients belonged to social class 3. Success rate of tube thoracostomy was 86% in unilateral cases, 50% in bilateral cases and 81% in all cases. Alternative treatment with  thoracotomy and decortications gave a success rate of 100%.

Conclusion: Thoracotomy with decortication is superior to tube   thoracostomy in paediatric non-traumatic pleural fl uid collection and
should be chosen as the primary treatment option when there is bilateral disease, chronicity, loculated effusion, thickened pleural membranes or trapped lung.

Keywords: Tube thoracostomy, Pleural fluid collections, Paediatric