(1456) Early Versus Late Chest Tube Placement in Necrotizing Pneumonia at a Rural Children’s Hospital

Introduction: The incidence of complicated pneumonia (parapneumonic effusion (PPE), pleural empyema (PLE), and necrotizing pneumonia (NP)) in pediatric patients is increasing. Clinical pathways for chest tube placement (CTP) and fibrinolytic therapy initiation in children with PPE and/or PLE have been associated with decreased hospital length of stay (hLOS). Early ( < 48 hours) vs. late (> 48 hours) CTP is associated with decreased hLOS in patients with PPE and/or PLE but this data is lacking in patients who have additional imaging findings of NP. We hypothesize early CTP with fibrinolytic therapy in these patients will not be associated with decreased hLOS.

Methods: Single center, retrospective chart review of patients admitted to the pediatric intensive care unit with complicated pneumonia requiring chest tube placement from January 2021 to June 2024. Demographics, radiographic diagnosis, hLOS, and CTP time were obtained from the medical record. Statistical analysis was performed using R with ‘dplyr’ package. Continuous variables were tested for normality with the Shapiro-Wilk test. Parametric variables were analyzed using t-tests, while non-parametric variables were analyzed with Mann-Whitney U tests. Categorical variables were analyzed with Fisher’s exact test.

Results: A total of 14 patients with NP in addition to PPE and/or PLE on imaging were included in this study. Median age was 3 years (IQR: 2 to 4 years). Median hLOS in early vs. late CTP was 14 days (IQR: 12.5 to 14.5 days) vs. 12 days (IQR: 10.5 to 19.5 days), respectively; p = 0.847. Median time to CTP was 14.8 hours (IQR: 7.4 to 39.9 hours) vs. 74.4 hours (IQR: 64.6 to 109.1 hours). There was no statistically significant difference (p > 0.3) in level of respiratory support (room air, nasal cannula, high flow nasal cannula, non-invasive positive pressure, endotracheal intubation) at time of CTP. All patients received fibrinolytic therapy.

Conclusions: Early ( < 48 hour) chest tube placement in pediatric patients admitted to a rural children’s hospital is not associated with decreased hLOS. Further studies are needed to understand if this association is influenced by timing of chest tube placement or use of fibrinolytic therapy.