P193 Impact of delayed radiographic detection of ipsilateral effusion on pleural infection outcomes

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Introduction and Objectives Pleural infection is a common clinical problem and despite improvements in diagnostic and therapeutic approaches is associated with significant morbidity and increased mortality. British Thoracic Society guidelines recommend chest tube drainage of complicated parapneumonic effusions and empyema.1 This project aimed to identify barriers to prompt diagnosis and subsequent management of pleural infection across 3 sites in within a major UK health board. Methods Data was collected between 12/01/2020 – 12/04/2020 in adults ≥16 treated for pleural infection requiring chest drain at the 3 sites. Patients with non-infective, transudative or malignant effusions were excluded. Results 23 patients were included. Male to female ratio was 14:9 with an age range of 17–81 years. 13/23 (57%) were septic on admission (defined by SIRS criteria) and 9/23 (39%) required admission to critical care (either high dependency or intensive care). 14/23 (61%) patients had complex parapneumonic effusion and 9/23 (39%) patients had empyema based on standard criteria. 7/23 (30%) were initially misdiagnosed as community acquired pneumonia (CAP) without effusion at first senior review. ‘Misdiagnosis’ was defined as formal reporting of an ipsilateral effusion by radiology when effusion was not recorded in the chest radiograph (CXR) interpretation section of the case notes. Misdiagnosis was associated with significantly longer time from CXR to ultrasound-guided aspiration and chest drain insertion and a 7-day increase in length of stay (LOS, see figure 1). Once pleural effusion was correctly identified and aspirated, 18/23 (78%) patients underwent chest drain insertion within 24-hours. Conclusions Accurate and early identification of pleural infection is associated with prompt drainage and shorter LOS, consistent with previous published literature2. Delayed diagnosis and intervention appeared associated with inaccurate interpretation of the admission CXR. A larger study is ongoing to expand on these findings and education sessions are planned in acute care settings, which may improve earlier diagnosis and shorten LOS. References Davies HE, Davies RJO, Davies CWH. Management of pleural infection in adults: British Thoracic Society pleural disease guideline 2010. Thorax 2010;65(2):41–53. Cham CW, Haq SM, Rahamim J. Empyema thoracis: a problem with late referral?Thorax 1993;48(3):925–7.

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