Purulent pericardial effusion in children: Experience from a tertiary care center in North India

Clinico-Epidemiological Profile of Children Admitted with Pericardial Effusion in a Tertiary Care Hospital: An Observational Study

Objectives

Pericardial effusion is rare in children, and the diagnosis is often delayed due to varied presentation and lack of classical Beck's triad manifestation. Delayed initiation of management leads to high mortality (30%). This study aimed to identify the clinico-epidemiological profile of children with pericardial effusion and their outcome.

Methods

This retrospective study was conducted at the pediatric intensive care unit of a tertiary care center in northern India from January 2019-September 2021, and included children (1 month-18 years) with pericardial effusion. History, clinical presentation, examinations, radiological and laboratory investigations were analyzed.

Results

Fifty-four children [median age 63 months (46.5, 132)] were included. Of these children, 78% had at least one feature of Beck's triad; muffling was predominant (42.6%). Overall, 35.2% had severe effusion. The incidence rates of tamponade (66.7%), muffling (68.4%), cardiomegaly (100%), and low voltage electrocardiography (100%) were higher in those with severe effusion compared to those without severe effusion (48.4%, 42.6%, 83.3%, 59.3% respectively). Overall, 44.4% of the children underwent pericardiocentesis, and 9.3% had pigtail catheterization. The children requiring pigtail catheter insertion underwent the procedure within 24 hours of admission. Pericardial effusion of tubercular etiology (19/54) mainly presented with breathlessness (84.2%), poor appetite (63.1%), and weight loss (42.9%), and the incidence rates of severe effusion and pericardiocentesis were 52.6% and 68.4%, respectively. Overall, the mean duration of pigtail catheter in situ was 11.4 days (±6.05), including 8.66 days (±3.77) in the non-tubercular group and 15.5 days (±6.5) in the tubercular group (p = 0.33).

Conclusions

Most of the children with pericardial effusion in this study had tubercular etiology, and most had a severe presentation and required pericardiocentesis. Early suspicion, even the presence of a single component of Beck's triad, may be helpful for prompt management.

Pericardial effusion in children at tertiary national referral hospital, Addis Ababa, Ethiopia: a 7-year institution based review

BACKGROUND

Pericardial effusion (PE) is a rare yet an important cause of child mortality due to collection of excess fluid in pericardial space. The study aimed to describe the PE profile in the national cardiac referral hospital, Addis Ababa, Ethiopia.

METHODS

The study employed cross-sectional study design for a 7-year review of childhood PE in Tikur Anbessa Specialized Hospital. Descriptive and analytic statistics were applied.

RESULTS

There were 17,386 pediatric emergency/ER admissions during the study period, and PE contributed to 0.47% of ER admissions. From 71 included subjects, 59% (42) were males with mean age of 7.8 ± 3.3 years. Cough or shortness of breath,73.2% (52) and fever or fast breathing, 26.7% (19), were the common presenting symptoms. The median duration of an illness before presentation was 14days (IQR: 8-20). The etiologies for pericardial effusion were infective (culture positive-23.9%, culture negative-43.6%, tuberculous-4.2%), hypothyroidism (4.2%), inflammatory (12.7%), malignancy (7%) or secondary to chronic kidney disease (1. 4%). Staphylococcus aureus was the most common isolated bacteria on blood culture, 12.7% (9) while the rest were pseudomonas, 7% (5) and klebsiella, 4.2% (3). Mild, moderate and severe pericardial effusion was documented in 22.5% (16), 46.5% (33), and 31% (22) of study subjects, respectively. Pericardial tamponade was reported in 50.7% (36) of subjects. Pericardial drainage procedure (pericardiocentesis, window or pericardiotomy) was performed for 52.1% (37) PE cases. The case fatality of PE was 12.7% (9). Pericardial drainage procedure was inversely related to mortality, adjusted odds ratio 0.11(0.01-0.99), p 0.049).

CONCLUSION

PE contributed to 0.47% of ER admissions. The commonest PE presentation was respiratory symptoms of around two weeks duration. Purulent pericarditis of staphylococcal etiology was the commonest cause of PE and the case fatality rate was 12.7%. Pericardial drainage procedures contributed to reduction in mortality. All PE cases should be assessed for pericardial drainage procedure to avoid mortality.