Ramnath R R, Heller R M, Ben-Ami T, Miller M A, Campbell P, Neblett W W, Holcomb G W, Hernanz-Schulman M
Department of Radiology, Vanderbilt Children's Hospital, Nashville, Tennessee 37232-2675, USA.
Pediatrics. 1998 Jan;101(1 Pt 1):68-71. doi: 10.1542/peds.101.1.68.
To devise a clinically relevant grading system for the sonographic evaluation of parapneumonic effusions, and to evaluate length of hospital stay as a function of treatment approach and sonographic grades.
Chest sonograms of 46 pediatric patients diagnosed with empyemas and admitted to two medical centers in the last 8 years were retrospectively evaluated using a grading system based on the degree of fibrinous organization within the parapneumonic effusions. Hospital charts were reviewed to determine the method of treatment and length of hospital stay. Patients were divided into two treatment groups: nonoperative (n = 26) (antibiotics alone, or combined with thoracentesis, or tube thoracostomy) and operative (n = 20) (open decortication, or video thoracoscopy and pleural debridement). Patients in the nonoperative group were further subdivided into two groups: those who received antibiotics alone (n = 11) and those who received antibiotics plus nonoperative drainage thoracentesis and/or tube thoracostomy (n = 15). Within each treatment group, patients were subdivided into two ultrasound grades: low (no evidence of organization) and high (evidence of organization such as fronds, septations, or loculations). Student's t test was performed to compare the lengths of hospital stay for each of the treatment groups and ultrasound grades.
The length of hospitalization was no different for patients with low-grade ultrasounds in the nonoperative (9.8 days) and operative groups (8.0 days). In contrast, length of hospitalization was significantly shorter for patients with high-grade sonograms in the operative group (8.6 days), when compared with the nonoperative group (16.4 days). Length of hospitalization for patients in the nonoperative group with high-grade sonograms was significantly longer (16.4 days) than for those with low-grade ultrasounds (9.8 days). Furthermore, when the nonoperative patients were divided into an antibiotics alone group and a nonoperative drainage group, the patients with low-grade sonograms had no difference in the length of hospitalization (9.0 days vs. 10.4 days), whereas those patients with high-grade sonograms in the nonoperative drainage group had a significantly longer hospitalization (19.9 days) than the antibiotics alone (high-grade) group (11.4 days).
Patients with a low-grade sonogram had similar length of hospitalization if treated with either nonoperative or operative measures. Patients with high-grade sonograms had significantly shorter length of hospitalization when treated with decortication. Our retrospective study suggests that patients with high-grade ultrasound studies treated nonoperatively do not benefit from pleural drainage procedures or chest tube placement. This study demonstrates the usefulness of early sonographic evaluation of parapneumonic effusions. A prospective study evaluating the usefulness of sonographic assessment of severity of disease in the treatment of children with parapneumonic effusions is warranted on the basis of our retrospective data.
设计一种用于超声评估肺炎旁胸腔积液的临床相关分级系统，并评估住院时间作为治疗方法和超声分级的函数。
回顾性评估过去8年中在两个医疗中心确诊为脓胸并入院的46例儿科患者的胸部超声检查结果，采用基于肺炎旁胸腔积液内纤维组织化程度的分级系统。查阅医院病历以确定治疗方法和住院时间。患者分为两个治疗组：非手术组（n = 26）（单独使用抗生素，或联合胸腔穿刺术，或胸腔闭式引流术）和手术组（n = 20）（开放剥脱术，或电视胸腔镜检查及胸膜清创术）。非手术组患者进一步分为两组：单独接受抗生素治疗的患者（n = 11）和接受抗生素加非手术引流胸腔穿刺术和/或胸腔闭式引流术的患者（n = 15）。在每个治疗组内，患者分为两个超声分级：低分级（无组织化证据）和高分级（有组织化证据，如叶状、分隔或分隔腔）。进行Student t检验以比较每个治疗组和超声分级的住院时间。
非手术组（9.8天）和手术组（8.0天）中低分级超声患者的住院时间无差异。相比之下，手术组中高分级超声患者的住院时间（8.6天）明显短于非手术组（16.4天）。非手术组中高分级超声患者的住院时间（16.4天）明显长于低分级超声患者（9.8天）。此外，当将非手术患者分为单独使用抗生素组和非手术引流组时，低分级超声患者的住院时间无差异（9.0天对10.4天），而非手术引流组中高分级超声患者的住院时间（19.9天）明显长于单独使用抗生素（高分级）组（11.4天）。
低分级超声患者采用非手术或手术措施治疗时住院时间相似。高分级超声患者采用剥脱术治疗时住院时间明显缩短。我们的回顾性研究表明，非手术治疗的高分级超声检查患者无法从胸膜引流程序或胸腔置管中获益。本研究证明了早期超声评估肺炎旁胸腔积液的有用性。基于我们的回顾性数据，有必要进行一项前瞻性研究，评估超声评估疾病严重程度在肺炎旁胸腔积液儿童治疗中的有用性。
