Usefulness of the British Thoracic Society and the American College of Chest Physicians guidelines in predicting pleural drainage of non-purulent parapneumonic effusions

SummaryAimTo assess the value of the British Thoracic Society (BTS) and the American College of Chest Physicians (ACCP) guidelines to predict which patients with non-purulent parapneumonic effusions (PPE) warrant chest tube drainage.MethodsA retrospective chart review was performed on all patients who underwent thoracentesis because of a PPE over a 10-year period at a Spanish medical center. Classification of PPE as complicated (CPPE) or uncomplicated (UPPE) was based on the clinician's decision to insert a chest tube to resolve the effusion. Empyema was defined as pus in the pleural space. Data collected included patient demographics, size of the effusion, and microbiological and pleural fluid chemistries that might influence the physician's decision to place a chest tube.ResultsOf the 240 patients with PPE who entered the study, 85 had UPPE, 67 had CPPE, and 88 had empyema. Individual pleural fluid parameters, namely a pH<7.20, a glucose<40mg/dL or <60mg/dL, a LDH>1000U/L or a positive culture had a relatively high specificity (from 78% for LDH to 94% for glucose