Limitations and strengths
Our study has several limitations. First, it is single center, which
limits its external validity. Second, the retrospective design increases
the risk of information bias. Third, the use of corticosteroids was not
strictly protocolized so that the criteria for initiating
corticosteroids may have varied from one child to another. Fourth, we
only collected data during the hospital stay: therefore, we cannot
exclude that corticosteroids are associated with worse outcomes after
hospital discharge. However, even though children with parapneumonic
effusions may have severe clinical, radiological and lung function
abnormalities during the acute phase of the disease, favorable and
complete recovery is the rule in the months following
infection29,30. Therefore, the benefits of
corticosteroids should be expected during the hospital stay or maybe in
the immediate post-hospital phase, but not in the long term. Fifth,
microbiological, clinical and management changes may have occurred
during the 15-year study period, and data observed 15 years ago may not
be representative of what occurs nowadays. The main strengths of our
study are the size of our cohort, and most importantly the fact that our
study is the first to describe the successful use of corticosteroids in
the management of parapneumonic effusion when non-surgical management is
considered a failure.