PURPOSE: Even though the presence of parapneumonic effusions (PPE) in hospitalized patients with community-acquired pneumonia (CAP) is associated with poor clinical outcomes, there are minimal data regarding quality of PPE management. The objective of this study was to evaluate the local level of compliance with ACCP 2000 guidelines for the management of PPE.
METHODS: Five hundred consecutive hospitalized patients with CAP were reviewed to identify patients with PPE. A set of four quality indicators (QIs) previously developed by our group were used to assess local level of compliance with ACCP guidelines. The quality indicators were: QI 1: Timely evaluation of pleural space anatomy (EPSA); QI 2: Timely diagnostic thoracentesis; QI 3: Timely therapeutic drainage of pleural effusion; QI 4: Successful resolution of PPE at 30 days of follow-up.
RESULTS: PPE was identified in 60 patients, 50 of whom underwent EPSA (83%). Timely EPSA (QI 1) was performed in 46 of 60 patients (72%). Diagnostic thoracentesis was performed in 9 patients (32%) out of 28 in whom it was indicated. Timely pleural fluid sampling (QI 2) was performed in 3 of 28 patients (11%). Timely therapeutic drainage of pleural fluid (QI 3) was done in 1 out of 3 patients in whom it was indicated. Successful resolution of PPE (QI 4) was documented in 23 of 44 evaluable patients.
CONCLUSION: Interventions to improve the evaluation and management of PPE are urgently needed at our institution.
CLINICAL IMPLICATIONS: Widespread suboptimal management of PPE may explain some of the poor patient outcomes associated with this common complication of CAP.
DISCLOSURE: Ervin Anaya, No Financial Disclosure Information; No Product/Research Disclosure Information