Evaluation of patiens diagnosed with pleural "effusion who hospitalized in pediatric thoracic service and pediatric intencive care within 2012 and 2015

Background: To analyze findings for physical examination, laboratory, and radiological examinations, of patients diagnosed with pleural effusion, who hospitalized in pediatric thoracic clinic and in pediatric intensive care unit, of Dicle University Faculty of Medicine, between January 2012 and December 2015; to compare this study with other studies. Material and Method: In this study, conducted by Dicle University pediatrics department, between January 2012 and December 2015, data of 97 patients, diagnosed with pleural effusion who hospitalized in pediatric thoracic clinic and in pediatric intensive care unit, examined retrospectively. Results: 36 of the patients included to this study were 36 (37.1 %) girls, 61 (62.9 %) were boys. Age of the youngest case was 1-month-old, the oldest one was 18-years-old. Mean age of the cases was 6,31 ± 5. Of the patients, 31(32 %) were between 0 and 2-years old, 15 (15.5 %) were between 2 and 5-years old, 24 (24.7 %) were between 5 and 10 -years-old, 27 (27.8 %) were 10 and 18-years old. The most presenting complaints were dsypnea in 92 (94.8 %) patients, fever in 74 (76.3%), coughing in 60 (61.9 %), tachypnea in 45 (43.3 %), sputum in 25 (25.8 %) , chest pain in 13 (13.4 %). The average duration of symptoms in patients before appliying to clinic was 16.2 ± 8.9 days (range of 1-day and 45 days) . Of the patients, 59 (60.8 %) were followed up in pediatric intensive care unit and 38 (39.2 %) in pediatric thoracic clinic. Mean age of patients in transuda group was determined as 7.0 ± 8.0 years, in exuda group as 7.4 ± 6.9 years. When C-reactive protein (CRP) positive-patients and CRP negative-patients were compared, the duration of hospitalization in CRP-positive-patients was found more longer and statistically significant (p<0.05) . Also, in CRP-positive patients, ratio of pleural liquid and serum LDH was found higher and statistically significant (p<0.05). The patients hospitalized in intensive care unit and in clinic as compared in terms of luekocyte and CRP showed that values of leukocyte and CRP in the patients hospitalized in intensive care unit were higher and statistically significant (p<0.05). Patients with parapneumonic effusion and without parapneumonic effusion were compared in terms of MCV (mean corpuscular volume) and platelets, showed that values of MCV and platelets in patients with parapneumonic effusion were higher and statistically significant (p<0.05) . Correlation analysis showed that as CRP levels increased, sedimentation and levels of leokocyte also increased. Conclusion: The most common cause of pleural effusion in pediatric patients is effusion develops secondary to pneumonia. In literature, the incidence of parapneumonic effusions, in boys is higher than in girls and right lung involvement is more common than the left lung involvement. in our study group, similarly, it was determined that pleural effusion, most commonly develops secondary to pneumonia, and was more frequently seen in boys. Likewise, the right lung involvement was seen more often than the left. Renovation of the pleura, and recovery capabilities in children are better than the adults, so it is recommended that medical treatment is to be first given to patients. In case of delayed treatment of empyema effusions may proceed. The patients, with pleural effusion or empyema that were not benefit from medical treatment within 48 hours and, with fever, may require tube thoracostomi in order to drain the effusion. In our study, the majority of the patients were benefit from medical treatment, and ratio of tube thoracostomi was lower than in other studies. It was determined that the majority of our patients were monitored in intensive care unit and, because of accompaniying systemic diseases and malignancies, our ratio of death was high. Pleural effusion, can cause significant morbidity and mortality if not diagnosed and treated early. Therefore, in these patients diagnosis should be done as early as possible, in appropriate cases thoracentesis for transudate-exudate distinction should be done, required cultural materials should be taken, in refractory cases to treatment additional systemic disease and malignancy should be considered. In critically ill patients, with an appropriate approach, it will be possible to reduce the mortality and morbidity. Keywords: Pediatric Chest, Pleural Effusion, Pneumonia