Authors: Charles A James Leah E Braswell Amir H Pezeshkmehr Paula K Roberson James A Parks Mary B Moore
Publish Date: 2016/10/05
Volume: 47, Issue: 1, Pages: 89-95
Abstract
We retrospectively reviewed the medical record to identify children and young adults who received fibrinolytic therapy for parapneumonic effusion and had chest tube placement by an interventional radiology service at a single children’s hospital We assessed tissue plasminogen activator tPA dosing and treatment duration as well as the need for a second pleural procedure or surgical drainage Diagnostic US images were classified as showing less than 50 pleural echogenicity grade 1 or greater than 50 pleural echogenicity grade 2 and were correlated with clinical parametersOf 32 patients with parapneumonic effusion all except one received at least some 1mg tPA doses Dosing was solely 1mg tPA in 81 of subjects 19 of subjects also received 2mg tPA doses Mean fibrinolytic duration was 31 days for grade 1 effusions compared to 54 days for grade 2 effusions A second pleural procedure was required in 156 of children Pleural drainage with fibrinolytic therapy was successful in 97 only one child required surgical drainage Grade 2 US differed significantly from grade 1 US with grade 2 occurring in younger patients P 00001 smaller patients P 00001 those needing a second procedure P = 0001 those with positive pleural culture or polymerase chain reaction test P = 0006 and those with longer treatment duration P = 003A lower 1mg dosing regimen of tissue plasminogen activator was effective in all children with less complex grade 1 US imaging parapneumonic effusions Grade 2 US images correlated with younger and smaller children presence of a pleural organism and longer or more complicated chest tube durationThis project was supported by the Translational Research Institute TRI grant UL1TR000039 through the National Institutes of Health NIH National Center for Research Resources and National Center for Advancing Translational Sciences The content is solely the responsibility of the authors and does not represent the official views of the NIH
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