Benefit of systematic management of pleural effusions using thoracic ultrasound: a prospective randomized study: ECHOPLEV

<bold>Objectives:</bold> In 2015, direct ultrasound localisation for pleural effusion management is not universal. The main objective of the study was to evaluate the differential cost-effectiveness ratio of two strategies for managing pleural effusion: with (US) and without thoracic (WUS) ultrasound. <bold>Method:</bold> This is an open single-center randomized controlled trial started in July 2015. <bold>Results:</bold> 127 patients were randomized. The main diagnoses at 1 month is infectious in 74.3% and 70% of cases (including 42% of purulent pleural effusion and 28%). At 1 month, 3 months, 6 months and 12 months; respectively 66%, 64.8%, 52.2% and 49.9% of patients have radiological sequelae. At visit M1, the duration of hospitalization was on average 10.5 days (+/-6.7) in the US group and 11.8 days (+/-10.4) in the WUS group. During the year of follow-up, we observed:7.0 complications/person.year (95% CI = [4.1; 12.2]) in the WUS group and 5.4 complications/person.year (95% CI = [3.1; 9.2]) in the US group. In the US group the average MsV irradiation rates were 5.18 and in the WUS group 6.01. The duration of hospitalizations was shorter in the first month in the US group and the associated costs were lower. <bold>Conclusion:</bold> The cost-effectiveness ratio of US in pleural effusions favors its use, limiting irradiation and complications. Sequelae after-effects are common and justify systematic ultrasound-guided management of pleural effusions.