Parapneumonic effusions (PPE) is a complication of bacterial pneumonia. Factors that contribute to complicated PPE remain uncertain. This study was aimed to describe the characteristics, clinical predictors and outcome of children with parapneumonic effusion (PPE) in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). A retrospective study on children with PPE who were admitted to UKMMC between January 2010 to December 2017 was conducted. Patients were categorised into 2 groups: simple and complicated PPE. Of 45 patients recruited, 20 (44.4%) patients had simple PPE and 25 (55.6%) had complicated PPE. Their median age was 32 months (IQR 16-63). The most common isolated organism was Streptococcus pneumoniae (61.9%), followed by Mycoplasma pneumoniae (19.0%) and Staphylococcus aureus (4.8%). Only 11.1% of patients received pneumococcal vaccination. There was no statistical significant difference in clinical features between simple and complicated PPE. Only 62.2% patients had ultrasound thorax done. Majority (95.0%) of patients with simple PPE were successfully treated with intravenous antibiotics alone. Sixty percent of patients with complicated PPE needed surgical intervention. Mean length of hospital stay for simple PPE was 10 (4.0) days and complicated PPE was 28 (16.5) days. In conclusion, clinical features could not predict complicated PPE. Use of ultrasound thorax as the main investigation tool for diagnosis and staging should be emphasised. Antibiotics therapy alone is effective therapy for simple PPE, while in complicated PPE, larger prospective studies are required to investigate which children benefit significantly from more intensive intervention.
Clinical Characteristics, Predictors and Outcome of Children with Complicated Parapneumonic Effusion: A Single Centre Experience
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Jangkitan bakteria di paru-paru boleh menyebabkan pengumpulan cecair pada bahagian pleura, dikenali sebagai parapneumonia efusi (PPE). Faktor ramalan kepada tahap kerumitan PPE tidak di ketahui. Kajian ini dilakukan untuk mengenali ciri-ciri, faktor ramalan dan hasil rawatan kanak-kanak yang mengalami PPE di Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM). Data pesakit PPE kanak-kanak yang dimasukkan ke PPUKM dari Januari 2010 ke Disember 2017 dikaji secara retrospektif. Pesakit dibahagikan kepada dua kumpulan iaitu PPE tahap sederhana dan PPE tahap rumit. Dari 45 orang pesakit yang dikaji, 20 (44.4%) pesakit mempunyai PPE tahap sederhana, manakala 25 (55.6%) mengalami PPE tahap rumit. Median umur pesakit adalah 32 bulan (IQR 16-63). Jenis bakteria yang paling biasa di temui adalah Streptococcus pneumoniae (61.9%), diikuti oleh Mycoplasma pneumoniae (19.0%) dan Staphylococcus aureus (4.8%). Didapati hanya 11.1% pesakit kanak-kanak menerima suntikan vaksin pneumokokal. Tiada perbezaan yang ketara dalam perbandingan ciri-ciri klinikal antara pesakit PPE tahap sederhana dan rumit. Ujian ultrasound toraks hanya dilakukan ke atas 62.2% pesakit. Majoriti (95.0%) pesakit PPE tahap sederhana sembuh dengan hanya rawatan antibiotik. Manakala 60.0% dari pesakit PPE tahap rumit memerlukan rawatan intervensi surgeri. Purata jangkamasa pesakit menerima rawatan di hospital bagi PPE sederhana adalah 10 (4.0) hari, manakala bagi PPE rumit adalah 28 (16.5) hari. Kesimpulannya, ciri-ciri klinikal tidak dapat meramal tahap kerumitan PPE. Penggunaan ujian ultrasound toraks sebagai ujian utama dalam diagnosis dan tahap PPE perlu ditekankan. Rawatan antibiotik adalah berkesan untuk PPE tahap sederhana, manakala untuk PPE tahap rumit, kajian prospektif yang lebih besar diperlukan untuk menentukan kumpulan kanak-kanak yang bermanafaat untuk menerima rawatan intervensi lebih intensif.
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