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 MF ratio of 21. 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 fluid collection and should be chosen as the primary treatment option when there is bilateral disease; chronicity; loculated effusion; thickened pleural membranes or trapped lung