Do All Children With Complicated Pneumonia Need a Procedural Intervention?

Abstract

Background: Current guidelines recommend that all children with complicated pneumonia need an invasive procedure to effect drainage. It is unknown whether some subgroups can be safely managed conservatively with antibiotics alone. Objectives: To compare the outcomes of children with complicated pneumonia managed conservatively to those managed with a procedure [chest tube (CT) +/- fibrinolytics or video-assisted thorascopic surgery (VATS)]. Design/Methods: Children with ultrasound-confirmed complicated pneumonia (parapneumonic effusions with loculations and/or septations) were recruited to a single-center prospective observational study (10/08-10/09). The primary outcome was hospital length of stay (LOS); secondary outcomes included readmissions, complications (pneumothorax, bronchopleural fistula, bleeding), and 1 month parameters [persistent effusions, parent- and child-reported quality of life (Peds-QL), school/work loss, and normalized spirometry (FEV1 >80% predicted)]. Bivariate comparisons were made between those treated conservatively and those treated with a procedure for outcomes and co-interventions (vancomycin, multiple antibiotics, opiates) using Chi squared, Fisher's exact, or independent t-tests, as appropriate. A stepwise multivariate linear regression adjusted for age, sex and significant (p