Role of Thoracic Ultrasound in the Management of Parapneumonic Effusion According to the Proposed Algorithm/Classification in Pediatric Pneumonia: A Single Center Study.

Background and Objective: Parapneumonic effusion refers to any pleural effusion secondary to pneumonia. Thoracic ultrasound is the imaging modality of choice for evaluating pleural effusion. This study aimed to assess the role of thoracic ultrasound, guided by a proposed algorithm and classification system, in the management of parapneumonic effusion and the prevention of related complications in children with pneumonia. Methods: Between 2020 and 2022, children presenting with clinical symptoms of pneumonia were evaluated by pediatricians at Akbar Children's Hospital in Mashhad. Patients with chest X-rays suggestive of parapneumonic effusion were enrolled. Management and treatment were guided by a specialist-designed algorithm. Patients were stratified into two groups: those with underlying disease and those without. Each group was analyzed separately. Results: Among the 105 enrolled children, 48 had underlying conditions and 57 did not. Ultrasound revealed pulmonary consolidation in all cases. The most frequent effusion stage in both groups was < 10 mm (43.9% in patients without underlying disease and 58.3% in those with underlying disease). None of the patients with stage II or III effusion who received algorithm-based treatment progressed to a higher stage during follow-up. A significant increase in complications was observed among patients initially admitted with advanced effusion stages ( Conclusion: The findings suggest that implementing the proposed ultrasound-based algorithm/classification system is effective tools in managing parapneumonic effusion and preventing complications in pediatric pneumonia.