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).