Chest
Volume 115, Issue 3, March 1999, Pages 751-756
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Clinical Investigations
Chest Tubes
Predicting Factors for Outcome of Tube Thoracostomy in Complicated Parapneumonic Effusion or Empyema

https://doi.org/10.1378/chest.115.3.751Get rights and content

Study objectives

To determine the predicting factors for outcome of tube thoracostomy in patients with complicated parapneumonic effusion (CPE) or empyema.

Design and settings

Retrospective chart review over a 55-month period at a tertiary referred medical center.

Patients and measurements

The medical charts of patients with empyema or CPE were reviewed. Data including age, gender, clinical symptoms, important underlying diseases, leukocyte count, duration of preadmission symptoms, interval from first procedure to second procedure, the time from first procedure to discharge (recovery time), the amount of effusion drained, administration of intrapleural streptokinase, chest tube size and position, loculation of pleural effusion, and characteristics and culture results of pleural effusion were recorded and compared between groups of patients with successful and failed outcome of tube thoracostomy drainage.

Results

One hundred twenty-one patients were selected for study. One hundred of these patients had received tube thoracostomy drainage with 53 successful outcomes and 47 failed outcomes of chest tube drainage. Nineteen patients received decortication directly, and the other two received antibiotics alone. Univariate analysis showed that pleural effusion leukocyte count, effusion amount, and loculation of pleural effusion were significantly related to the outcome of chest tube drainage. Multiple logistic regression analysis demonstrated that loculation and pleural effusion leukocyte count ≤ 6,400/μL were the only independent predicting factors related to failure of tube thoracostomy drainage.

Conclusions

Loculation and pleural effusion leukocyte count ≤ 6,400/μL were independent predicting factors of poor outcome of tube thoracostomy drainage. These results suggest that if the initial attempt at chest tube drainage fails, early surgical intervention should be considered in good surgical candidates with loculated empyema or pleural effusion with leukocyte count ≤ 6,400/μL.

Section snippets

Patient Characteristics

We retrospectively analyzed the medical records of 121 patients with empyema or CPE treated from January 1993 to July 1997 at National Cheng Kung University Hospital, a tertiary referred medical center in southern Taiwan. Empyema was defined as pleural effusion that met one or more of the following criteria: (1) grossly purulent fluid; (2) positive effusion culture; and (3) positive Gram's stain for bacteria. CPEs were defined as parapneumonic effusion with one or more of the following criteria6

Patients Characteristics

One hundred twenty-one patients were included in the present study. The mean ± SD age of the study population was 59 ± 15 years. Male gender was more frequent (99 men vs 22 women). Among the 121 patients, the most common causes of empyema or CPE were pneumonia (65%) and lung abscess (16%) (Table 1). The most frequent clinical symptoms were fever (76%), chest pain (65%), cough (55%), and dyspnea (44%). The most frequent underlying conditions were diabetes mellitus (29%), malignancy (12%),

Discussion

The success rate for conventional tube thoracostomy drainage is 32 to 71%.4 Mandal and Thadepalli8 reported a 93% cure rate for patients treated by chest tube drainage alone. Their study was limited to patients with bacterial empyemas and excluded effusions caused by trauma, surgical intervention, esophageal diseases, or malignant diseases. The overall success rate of 53% in our study is comparable to that reported from other studies.9,10,11Substantial mortality rates from empyema have been

References (38)

  • TAA Mackinlay et al.

    VATS debridement versus thoracotomy in the treatment of loculated postpneumonia empyema

    Ann Thorac Surg

    (1996)
  • DR Lawrence et al.

    Thoracoscopic debridement of empyema thoracis

    Ann Thorac Surg

    (1997)
  • H Hamm et al.

    Parapneumonic effusion and empyema

    Eur Respir J

    (1997)
  • TL Lee-Chiong

    Treating empyema without surgery

    Postgrad Med

    (1997)
  • DD Stark et al.

    CT and radiographic assessment of tube thoracostomy

    AJR AM J Roentgenol

    (1983)
  • RW Light
  • JA Hanley et al.

    The meaning and use of the area under a receiver operating characteristic (ROC) curve

    Radiology

    (1982)
  • AK Mandal et al.

    Treatment of spontaneous bacterial empyema thoracic

    J Thorac Cardiovasc Surg

    (1987)
  • TL Lee-Chiong et al.

    Current diagnostic methods and medical management of thoracic empyemas

    Chest Surg Clin North Am

    (1996)
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