Survey of hospital procedures for parapneumonic effusion in children highlights need for standardised management

• Published in: Acta Paediatrica Vol. 103; no. 9; pp. e393 - e398
• Main Authors: Le Mée, A, Mordacq, C, Lagrée, M, Deschildre, A, Martinot, A, Dubos, F
• Format: Journal Article
• Language: English
• Published: Norway Blackwell Publishing Ltd 01.09.2014; Wiley Subscription Services, Inc
• Subjects: Adult; Anti-Bacterial Agents - therapeutic use; Antibiotic therapy; Antibiotics; Child; Children; Evaluation; Female; Health Care Surveys; Health Services Needs and Demand; Hospitals; Hospitals, University; Humans; Male; Management; Parapneumonic effusion; Patient Care Management - standards; Pediatrics; Pleural Effusion - drug therapy; Pleural Effusion - microbiology; Practice Patterns, Physicians; Streptococcus infections; Surveys and Questionnaires; Evaluation; Children; Management; Parapneumonic effusion; Antibiotic therapy
• ISSN: 0803-5253; 1651-2227
• DOI: 10.1111/apa.12702

Aim This study sought to evaluate the initial management of children with parapneumonic effusion admitted to all French university hospitals. Methods A nationwide survey of all 35 university hospitals took place in 2011 to assess practices for children with parapneumonic effusion, using a hypothetical clinical vignette and a standardised questionnaire. Two to four paediatricians per hospital were interviewed and asked about their initial management, probabilistic antibiotic therapy and its adaptation to microbiological results and subsequent course. Answers from paediatricians working in emergency departments, intensive care units and conventional paediatric units were compared. Results Of the 100 paediatricians contacted, 95 responded. Of these, 98% would order an initial blood test, 70% would order diagnostic thoracentesis, and all would start immediate antibiotic therapy: 31% with a single drug, 67% with two drugs and 2% with three drugs. The most frequent initial choices were third‐generation cephalosporin alone (17%) or combined with rifampicin (34%) or vancomycin (24%). Adaptation varied according to drug used, dose and duration, especially when the microorganism was not Streptococcus pneumoniae. Practices did not differ significantly among the different groups of paediatricians. Conclusion Standardised management of parapneumonic effusion, including routine thoracentesis and more consistent prescription of antibiotics, is needed.