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Management of pleural effusion and empyema in a third-level pediatric surgical center: what has changed after the introduction of a new diagnostic and therapeutic algorithm?
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  • Alessandro Boscarelli,
  • Lucrezia Gentile,
  • Manuela Giangreco,
  • Edoardo Guida,
  • Maria-Grazia Scarpa,
  • Damiana Olenik,
  • Jürgen Schleef,
  • Daniela Codrich
Alessandro Boscarelli
IRCCS Materno Infantile Burlo Garofolo Dipartimento di Chirurgia

Corresponding Author:[email protected]

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Lucrezia Gentile
University of Trieste
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Manuela Giangreco
IRCCS Materno Infantile Burlo Garofolo
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Edoardo Guida
IRCCS Materno Infantile Burlo Garofolo Dipartimento di Chirurgia
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Maria-Grazia Scarpa
IRCCS Materno Infantile Burlo Garofolo Dipartimento di Chirurgia
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Damiana Olenik
IRCCS Materno Infantile Burlo Garofolo Dipartimento di Chirurgia
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Jürgen Schleef
IRCCS Materno Infantile Burlo Garofolo Dipartimento di Chirurgia
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Daniela Codrich
IRCCS Materno Infantile Burlo Garofolo Dipartimento di Chirurgia
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Abstract

Background: Pleural effusion and empyema are frequent complications of acute bacterial pneumonia in children. To date, evidence regarding the optimal treatment of this condition is limited in the literature. Methods: Patients with pleural effusion and empyema admitted at our Pediatric Surgery Department over the last ten years were enrolled in this retrospective study, and successively compared with the clinical charts of patients treated before the introduction of a new diagnostic and therapeutic algorithm. Results: After the introduction of the new algorithm there were a decrease in the use of chest radiography for re-evaluation (100% vs. 79%, p = 0.003), a more focused use of CT (68% vs. 15%, p = 0.001), and a decrease in the use of a second CT (18% vs. 3%, p = 0.07); in favor of an increase in the use of the US scan (40%vs 100%, p=0.001). There was also a shift from the use of chest tube drainage alone to the use of drainage for Urokinase administration (50% vs. 92.3%, p = 0.001), and a statistically significant decrease in the need for video-assisted thoracoscopic surgery (25% vs. 7.7%, p = 0.001). Conclusions: The introduction of a diagnostic and therapeutic algorithm for the management of pediatric pleural effusion and empyema has notably resulted in a decrease in the utilization of radiography and computed tomography and an increase in the use of ultrasonography, reducing unnecessary radiation exposure in children and overall costs.