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Paediatric empyema: are ultrasound characteristics at the time of intervention predictive of treatment failure?
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  • Stuart Haggie,
  • Hiran Selvadurai,
  • Hasantha Gunasekera,
  • Dominic Fitzgerald,
  • David Lord,
  • Murthy Chennapragada
Stuart Haggie
Children's Hospital at Westmead

Corresponding Author:[email protected]

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Hiran Selvadurai
The Children\'s Hospital at Westmead
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Hasantha Gunasekera
Children's Hospital at Westmead
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Dominic Fitzgerald
The Children's Hospital at Westmead
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David Lord
Children's Hospital at Westmead
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Murthy Chennapragada
Children's Hospital at Westmead
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Abstract

Background: Parapneumonic effusions and empyema are the most frequent complication of paediatric pneumonia. Treatment options include chest drain and fibrinolytics (CDF) or thoracoscopic surgery. CDF is considered less invasive, more cost effective though with higher rates of reintervention. Pleural fluid characteristics on ultrasound may identify cases at increased risk of treatment failure with primary CDF. Methods: A retrospective cohort 2011-2018 of complicated pneumonia managed with primary CDF. Cases were reviewed using ultrasound criteria to describe pleural fluid. We compared ultrasound findings and treatment failure. Results: We report 137 cases with a median age 3.8 years and 43% female. Treatment failure occurred for 32/137 (23%) cases. The interobserver reliability was substantial for the number of septations (Kappa 0.72, 95% CI 0.6 to 0.8), moderate for the size of the largest locule (Kappa 0.55, 95% CI 0.4 to 0.7) and fair for the level of echogenicity (Kappa 0.22, 95%CI 0.1 to 0.3), pleural thickening (Kappa 0.28, 95% CI 0.2 to 0.4), maximum effusion depth (Kappa 0.37, 95%CI 0.2 to 0.5) and radiologist’s risk for reintervention (Kappa 0.32, 95% CI 0.2 to 0.5). Hyperechoic pleural fluid was associated with treatment failure, with cases nearly five times more likely than anechoic fluid to have a reintervention (OR 4.9 95%CI 1.7 to 14.2, p=0.04). Treatment failure was not associated with other variables. Conclusion: We did not find an association between ultrasound characteristics and treatment failure for complicated pneumonia managed with primary CDF. Inter-observer agreement of ultrasound findings was difficult despite more objective criteria.
07 Oct 2021Submitted to Pediatric Pulmonology
07 Oct 2021Submission Checks Completed
07 Oct 2021Assigned to Editor
28 Oct 2021Reviewer(s) Assigned
06 Jan 2022Review(s) Completed, Editorial Evaluation Pending
18 Jan 2022Editorial Decision: Revise Major
30 Mar 20221st Revision Received
30 Mar 2022Submission Checks Completed
30 Mar 2022Assigned to Editor
30 Mar 2022Reviewer(s) Assigned
13 Apr 2022Review(s) Completed, Editorial Evaluation Pending
18 Apr 2022Editorial Decision: Accept