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Predictive Factors of Morbidity in Childhood Parapneumonic Effusion-associated Pneumonia: A Retrospective Study

Picard, Elie MD*; Joseph, Leon MB ChB, MRCPCH*; Goldberg, Shmuel MD*; Mimouni, Francis B. MD; Deeb, Maher MD; Kleid, David MD§; Raveh, David MD

The Pediatric Infectious Disease Journal: September 2010 - Volume 29 - Issue 9 - p 840-843
doi: 10.1097/INF.0b013e3181dd1fc4
Original Studies

Study Objective: To find the clinical and laboratory criteria that best predict a prolonged fever in children with parapneumonic effusion-associated pneumonia treated conservatively.

Design: Retrospective, cohort study.

Patients: Children admitted to the Shaare Zedek Medical Center between January 1, 1997, and December 31, 2006, and who had been discharged with a diagnosis of empyema and pleurisy.

Measurements and Results: One hundred-twenty children were included, all of whom were treated with antibiotics; in 80 patients, a thoracic drain was introduced; in 23, pleural tap was performed; and in 17 patients, no special procedure was performed. In no case was video-assisted thoracic surgery performed. The mean total days of fever was 12.8 ± 5.9 (2–29 days), and the mean length of stay at the hospital was 11.5 ± 4.9 (3–25) days. In 44 patients (37%), a bacterial culture was positive either in blood or in pleural fluid or both. A positive blood or a positive pleural fluid culture was significantly associated with a prolonged fever as was a history of an underlying disease. Platelet counts, serum Na, serum protein, pleural lactate dehydrogenase (LDH), pleural glucose, pleural/serum LDH ratio, pleural/serum glucose ratio, and pleural fluid pH were the only factors significantly but weakly correlated with the total duration of fever or duration of fever after admission. A “fever duration” score using platelet count, pleural fluid pH, pleural/serum LDH ratio, and pleural/serum glucose ratio predicted a prolonged course of fever (>7 days) with a sensitivity of 91% (95% confidence interval: 60%–100%) and a specificity of 47% (95% confidence interval: 25%–71%).

Conclusions: In children with parapneumonic effusion-associated pneumonia, a positive bacterial culture and an underlying disease are associated with prolonged fever. A low score based on platelet count, pH pleural fluid and glucose, and LDH pleural/serum ratio is associated with a prolonged fever. We speculate that children with the risk factors mentioned earlier may be the best candidates for an early aggressive approach.


From the Departments of *Pediatric Pulmonology, †Pediatrics, ‡Cardio-Thoracic Surgery, §Pediatric Intensive Care, and ¶Infectious Disease, Shaare Zedek Medical Center, affiliated to the Hebrew University, School of Medicine, Jerusalem, Israel.

Accepted for publication March 10, 2010.

All authors have no conflicts of interest.

Address for correspondence: Elie Picard, MD, Department of Pediatric Pulmonology, Shaare Zedek Medical Center, POB 3235, Jerusalem 91031, Israel. E-mail:

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© 2010 Lippincott Williams & Wilkins, Inc.