Incidence and outcome of scoliosis in children with pleural infection

Aims To ascertain the incidence and outcome of secondary scoliosis associated with parapneumonic effusions/empyema. Methods Retrospective review of case notes of children with pleural effusions over a 3‐year period. Review of digitalized erect chest radiographs by two observers with serial measurements of Cobb angles. Scoliosis defined as lateral curvature of the spine ≥10°. Results Of 122 children (median age 4.3 years), 103 (84%) required chest drains of whom 83/103 (81%) received urokinase; 5 (4%) required surgical decortication. On admission, 56 (46%) had a scoliosis, 68 (62%) on the 2nd radiograph, and 68 (59%) at discharge; overall 87 (71%) had a scoliosis at some stage. In all cases, there was a single thoracic curve with the direction towards the side of the effusion. There was no association between scoliosis and size or type of effusion, nor inflammatory markers. There was a statistically significant but small effect from duration of illness prior to admission. At follow‐up, 6 (5%) had a mild residual scoliosis but all subsequently resolved. Intraobserver variability for measurement of Cobb angles was ±4.6° and interobserver variability was ±5.8°. Conclusions Scoliosis was common but always resolved so therapy is unnecessary; follow up is recommended to exclude coincidental idiopathic scoliosis. Pediatr Pulmonol. 2007; 42:221–224. © 2007 Wiley‐Liss, Inc.