Incidence of parapneumonic empyema and complex parapneumonic effusion: A retrospective cohort study of 1766 pneumonia cases at a tertiary-level regional thoracic surgery referral center
Bibliographic record
Abstract
BACKGROUND: Both community and hospital acquired pneumonia (CAP & HAP) have potential to progress to parapneumonic empyema & complex effusion, with serious associated morbidity. Study objectives were threefold: to determine the annual incidence of empyema and complex effusion at our institution, identify independent predictors of progression from pneumonia to these complex effusions and to understand local practice management patterns.METHODS: A retrospective cohort study was conducted. A total of 1766 consecutive adult cases of pneumonia from November 1, 2014 to October 31, 2015 met inclusion criteria. The primary outcome of interest was incidence of parapneumonic empyema and complex effusion. Secondary outcomes included frequency of diagnostic and therapeutic pleural intervention. Variables of interest included basic demographics, and comorbidities as measured by the Charlson Comorbid Index (CCI). Statistical analysis involved descriptive, univariable and multivariable logistic regression.RESULTS: The local incidence risk of parapneumonic empyema and complex effusion was 10.76% (n = 190) over the study period. The majority of these arose secondary to HAP (72%). On multivariate analysis, exposures associated with the development of parapneumonic empyema included: peripheral vascular disease (PVD) (p = 0.002), COPD (p = 0.04) and high Charlson Comorbidity Index (p = 0.005).CONCLUSIONS: Our parapneumonic empyema and complex effusion incidence of 10.76%, we identified HAP, COPD and high Charlson Comorbidity Index, as important clinical variables portending an association of pneumonia with empyema. Future research directions should include prospective study on the impact of smoking history and current substance dependence effect on empyema, in addition to inquiry into why HAP is more likely to progress to empyema.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".