Pleural effusion in elderly hospitalised patients

The prevalence, symptoms, causes and natural history of pleural effusion in the elderly were studied in 4820 consecutive admissions (mean age 80 years) to an acute geriatric unit. Of 502 (10%) patients with evidence of pleural effusion on a chest X-ray (CXR), the medical notes were reviewed in 461. In 168 patients, pleural effusion was bilateral. The underlying causes were cardiac failure in 324 (70%), pneumonia in 202 (44%), malignancy in 58 (13%) and pulmonary infarction in 14 (3%). No case of active tuberculosis was identified, but additional diagnostic studies were done in only a minority of patients. The in-hospital mortality was 27% and at 12 month follow-up 60%. The presence of pleural effusion is a non-specific marker of a poor prognosis and justifies a more positive approach to diagnosis and more intensive management than is present practised.