To the Editor,
The management of parapneumonic
pleural effusion and pleural empyema (PPE/PE) is controversial1-3. Although fibrinolytics are considered to have
similar efficacy to video-assisted thoracoscopic surgery4,5, it is unknown when a drainage procedure for
PPE/PE is beneficial, and many patients recover satisfactorily with
antibiotic treatment alone 6-8. Because of the
potential severity and possible need for interventional procedures,
pediatric patients with PPE/PE are often transferred to tertiary
referral centers for treatment. The two hospitals participating in this
study (HA and HB) are tertiary centers equipped with pediatric intensive
care units (PICU), pediatric surgery and interventional radiology. Both
centers are located in southeast Spain, about 90 km apart, and serve as
reference centers for the other hospitals in their respective provinces,
each covering a population of just over 250,000 children under 15 years
of age. Despite these similarities and both hospitals’ extensive
experience caring for pediatric patients with PPE/PE, their treatment
policies for this condition diverged in 2010, when HA adopted a more
conservative (less interventional) approach 8. This
situation offers the opportunity to compare the clinical
characteristics, treatments and outcomes observed in two adjacent and
contemporaneous cohorts of patients with PPE/PE treated with different
criteria, analyzing the use of chest drainage and the length of hospital
stay (LOS).