Parapneumonic pleural effusions (PPE) are a common complication of pneumonias. Although several studies have suggested parameters to guide the management of PPE, this subject remain controversial. In this study we describe the outcome of patients with PPE treated based on a simple model of evaluation that guides the optimal therapeutic decision.
Seventy-five patients with PPE and negative bacteriological findings were evaluated according to their image (chest radiograms, ultrasound or CT scans) and pleural fluid (WBC counts, neutrophil percent and LDH levels) parameters. Based on the results of each parameter, models were created to test the sensitivity, specificity and predictive positive and negative values of the clinical or surgical (thoracostomy) therapeutic decision in predicting the outcome of the treated groups.
PPE patients with bacteriological negative findings and with small effusions, WBC < 1,000cels/mm3, %N < 75% and LDH < 1,000IU/L were clinically treated with a successful outcome (SE = 92%; SP = 90%). PPE patients with moderate or large effusions, or WBC > 1,000cels/mm3, %N > 75% or LDH > 1,000IU/L were treated with early chest tube drainage and successful outcome (SE = 95% and SP = 92%).
Simple models including the image evaluation of the pleural effusions and the levels of pleural fluid WBC, neutrophil percent and LDH were able to predict the optimal therapeutic decisions to treat patients with PPE with higher sensibility and specificity.
Simple models including few parameters can be applied in the clinical practice to predict the optimal treatment for patients with PPE.
Evaldo Marchi, None.