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1.
Respiration ; 99(3): 257-263, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32155630

RESUMEN

BACKGROUND: Malignant pleural effusion (MPE) poses a considerable healthcare burden, but little is known about trends in directly attributable hospital utilization. OBJECTIVE: We aimed to study national trends in healthcare utilization and outcomes among hospitalized MPE patients. METHODS: We analyzed adult hospitalizations attributable to MPE using the Healthcare Cost and Utilization Project - National Inpatient Sample (HCUP-NIS) databases from 2004, 2009, and 2014. Cases were included if MPE was coded as the principal admission diagnosis or if unspecified pleural effusion was coded as the principal admission diagnosis in the setting of metastatic cancer. Annual hospitalizations were estimated for the entire US hospital population using discharge weights. Length of stay (LOS), hospital charges, and hospital mortality were also estimated. RESULTS: We analyzed 92,034 hospital discharges spanning a decade (2004-2014). Yearly hospitalizations steadily decreased from 38,865 to 23,965 during this time frame, the mean LOS decreased from 7.7 to 6.3 days, and the adjusted hospital mortality decreased from 7.9 to 4.5% (p = 0.00 for all trend analyses). The number of pleurodesis procedures also decreased over time (p = 0.00). The mean inflation-adjusted charge per hospitalization rose from USD 41,252 to USD 56,951, but fewer hospitalizations drove the total annual charges down from USD 1.51 billion to USD 1.37 billion (p = 0.00 for both analyses). CONCLUSIONS: The burden of hospital-based resource utilization associated with MPE has decreased over time, with a reduction in attributable hospitalizations by one third in the span of 1 decade. Correspondingly, the number of inpatient pleurodesis procedures has decreased during this time frame.


Asunto(s)
Costos de la Atención en Salud/tendencias , Hospitalización/tendencias , Tiempo de Internación/tendencias , Derrame Pleural Maligno/terapia , Pleurodesia/tendencias , Toracocentesis/tendencias , Toracoscopía/tendencias , Toracostomía/tendencias , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/patología , Tubos Torácicos/economía , Tubos Torácicos/tendencias , Femenino , Neoplasias Gastrointestinales/complicaciones , Neoplasias Gastrointestinales/patología , Precios de Hospital/tendencias , Mortalidad Hospitalaria/tendencias , Hospitalización/economía , Humanos , Tiempo de Internación/economía , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Derrame Pleural Maligno/economía , Derrame Pleural Maligno/etiología , Pleurodesia/economía , Toracocentesis/economía , Toracoscopía/economía , Toracostomía/economía
2.
Nurs Times ; 108(11): 16-7, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22536712

RESUMEN

A number of risks and complications are associated with traditional chest drainage systems. A trust decided to trial digital drainage systems, and found the new systems improved treatment time and patient mobility.


Asunto(s)
Tubos Torácicos/tendencias , Monitoreo Fisiológico/enfermería , Enfermedades Pleurales/enfermería , Enfermedades Pleurales/terapia , Succión/enfermería , Equipos y Suministros , Humanos , Monitoreo Fisiológico/instrumentación , Monitoreo Fisiológico/tendencias , Succión/instrumentación , Succión/tendencias
3.
J Pediatr Surg ; 53(4): 644-646, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-28781127

RESUMEN

AIM: To assess the evolution in management of children with parapneumonic effusion and empyema in a tertiary referral centre. METHOD: We conducted a retrospective case note review of paediatric patients with parapneumonic effusion, pleural effusion and pleural empyema between December 2006 and December 2015. Digital database searches were performed to identify demographic data, referring hospital, radiological and microbiological investigations. Length of stay and morbidity were analysed. RESULTS: One hundred fifteen patients had 159 interventions over the study period. Fifty-four children were successfully treated with intercostal drainage (ICD) and urokinase fibrinolysis alone. There were 19 primary video assisted thoracoscopic surgeries (VATS) and 12 VATS after initial intercostal drains. Thirty-three children required a thoracotomy, a reduction of 26% from the previous era (p=0.009). The median length of stay was 9days (range 2-54). CONCLUSION: Parapneumonic effusion can be successfully treated with intercostal drainage and intrapleural fibrinolytics, but a proportion requires further surgical intervention. In our hospital, increased utilisation of fibrinolysis and VATS occurred with a corresponding decrease in the need for thoracotomy. Patients needing thoracotomy all had severe disease on ultrasound, but ultrasound did not reliably predict failure of fibrinolytic therapy. LEVEL OF EVIDENCE: III.


Asunto(s)
Empiema Pleural/terapia , Derrame Pleural/terapia , Pautas de la Práctica en Medicina/tendencias , Adolescente , Tubos Torácicos/estadística & datos numéricos , Tubos Torácicos/tendencias , Niño , Preescolar , Terapia Combinada/estadística & datos numéricos , Terapia Combinada/tendencias , Drenaje/estadística & datos numéricos , Drenaje/tendencias , Empiema Pleural/complicaciones , Empiema Pleural/diagnóstico , Femenino , Fibrinolíticos/uso terapéutico , Humanos , Lactante , Recién Nacido , Tiempo de Internación/tendencias , Masculino , Derrame Pleural/complicaciones , Derrame Pleural/diagnóstico , Estudios Retrospectivos , Centros de Atención Terciaria , Cirugía Torácica Asistida por Video/estadística & datos numéricos , Cirugía Torácica Asistida por Video/tendencias , Toracotomía/estadística & datos numéricos , Terapia Trombolítica/estadística & datos numéricos , Terapia Trombolítica/tendencias , Reino Unido
4.
J Pediatr Surg ; 51(6): 885-90, 2016 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-27032611

RESUMEN

PURPOSE: The purpose of this study was to examine trends in the treatment of patients with infectious parapneumonic effusions in U.S. children's hospitals over the past decade. METHODS: The PHIS database was queried for patients younger than 18years old with pneumonia and pleural effusion in three yearlong periods over the past decade. Variables included age, gender, payer, race/ethnicity, hospital region, hospital type, markers of illness severity, and treatment group (antibiotics alone, chest tube thoracostomy±thrombolytics, video-assisted thoracoscopy (VATS), or thoracotomy). RESULTS: 5569 patients were included in the final analysis. The proportion of patients treated with antibiotics alone increased from 62% to 74% from 2004 to 2014 (p<0.001). Among patients requiring pleural space drainage, the frequency of VATS peaked in 2009 (50.8%), dropping to 36.4% in 2014 (p<0.001), while tube thoracostomy, usually with fibrinolytics, rose from 39.0% in 2009 to 53.2% in 2014 (p<0.001). CONCLUSION: In a select cohort of free-standing, tertiary care U.S. children's hospitals, antibiotic administration alone remains the most common treatment approach to infectious parapneumonic effusions. VATS treatment for those patients requiring pleural space drainage is being gradually supplanted by thoracostomy tube placement with instillation of fibrinolytics.


Asunto(s)
Hospitales Pediátricos/tendencias , Derrame Pleural/terapia , Neumonía/complicaciones , Pautas de la Práctica en Medicina/tendencias , Adolescente , Antibacterianos/uso terapéutico , Tubos Torácicos/estadística & datos numéricos , Tubos Torácicos/tendencias , Niño , Preescolar , Bases de Datos Factuales , Drenaje/métodos , Drenaje/estadística & datos numéricos , Drenaje/tendencias , Femenino , Fibrinolíticos/uso terapéutico , Humanos , Lactante , Masculino , Derrame Pleural/etiología , Cirugía Torácica Asistida por Video/estadística & datos numéricos , Cirugía Torácica Asistida por Video/tendencias , Toracostomía/estadística & datos numéricos , Toracostomía/tendencias , Toracotomía/estadística & datos numéricos , Toracotomía/tendencias , Terapia Trombolítica/estadística & datos numéricos , Terapia Trombolítica/tendencias , Estados Unidos
5.
Pediatrics ; 134(3): e798-805, 2014 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-25092944

RESUMEN

BACKGROUND AND OBJECTIVE: Competence in the chest tube insertion procedure is vital for practitioners who take care of critically ill infants. The use of animals for training is discouraged, and there are no realistic simulation models available for the neonatal chest tube insertion procedure. The objective of this study was to assess the effectiveness of teaching the chest tube insertion procedure by using an easily constructed, nonanimal simulation model. METHODS: An inexpensive infant chest tube insertion model was developed by using simple hardware. A prospective cohort study with pre-posttest intervention design was conducted with pediatric and combined internal medicine-pediatrics residents. Residents completed a questionnaire about their previous experience of chest tube insertion, knowledge, self-evaluation of knowledge, comfort, and skills; pre, post, and a month after an individualized education session and demonstration of the procedure on the model. Clinical skills were assessed by using a 32-point scoring system when residents performed the procedure on the model immediately after training and a month later. RESULTS: All residents had significant improvement in knowledge and self-evaluation of knowledge, comfort, and skills scores after the education session and training on the model and this improvement was retained after 1 month (P < .001). Clinical skills scores decreased slightly 1 month after training (P = .08). Scores were not significantly different between the levels of trainees. CONCLUSIONS: An educational intervention using an easily constructed and inexpensive chest tube insertion model is effective in improving knowledge, comfort, and skills in trainees. The model can be used repeatedly to maintain proficiency.


Asunto(s)
Tubos Torácicos/tendencias , Competencia Clínica , Internado y Residencia/tendencias , Intubación Intratraqueal/tendencias , Invenciones/tendencias , Maniquíes , Estudios de Cohortes , Humanos , Recién Nacido , Intubación Intratraqueal/métodos , Estudios Prospectivos
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