North Pacific Surgical Association
Outcomes associated with type of intervention and timing in complex pediatric empyema

https://doi.org/10.1016/j.amjsurg.2012.01.005Get rights and content

Abstract

Background

The presence of effusion/empyema in pediatric pneumonia can increase treatment complexity by possibly requiring pleural drainage. Currently, no data support the superiority of any drainage modalities in children.

Methods

We performed a retrospective cohort study using the Pediatric Health Information System database from 2003 to 2008.

Results

A total of 14,936 children were hospitalized with effusion/empyema. Fifty-two percent of children were treated with antibiotics alone. Compared with patients receiving a chest tube, patients receiving antibiotics alone, thoracotomy, and video-assisted thoracoscopic surgery had a shorter length of stay, lower mortality rates, and fewer re-interventions. Delaying drainage by 1 to 3 days was associated with a lower mortality rate, and a delay of more than 7 days was associated with a higher mortality rate.

Conclusions

Half of all children with effusion/empyema are treated with antibiotics alone with low morbidity and mortality. Initial video-assisted thoracoscopic surgery or thoracotomy had improved outcomes compared with other interventions. Intervention should not be delayed beyond 7 days.

Section snippets

Data source

We used the Pediatric Health Information System (PHIS) database developed by the Child Health Corporation of America, which includes demographic, diagnostic, and charge data for 40 freestanding, noncompeting, children's hospitals. The PHIS database includes both diagnoses and procedures coded by using the International Classification of Diseases, 9th revision, clinical modification (ICD-9-CM) format. This study was approved by the institutional review board of the Seattle Children's Hospital,

Results

A total of 14,936 children were identified. The distribution of index interventions showed significant variability across the institutions within the PHIS database (Fig. 1). Within this population, 63% had codes for PPE, and 37% had codes for empyema with or without fistula. For the majority of the patients (70%), either of these diagnoses was recorded as the primary for the hospitalization. Patients diagnosed with PPE (concurrent diagnosis of pneumonia and pleural effusion) had a similar LOS

Empyema versus parapneumonic effusion

Although one can clinically assume that a patient with pneumonia and an effusion may have an empyema, or even infer based on ultrasound or computed tomography criteria that a patient has empyema, it is only by evaluation of the pleural fluid that one can definitively confirm the diagnosis. Pleural infection is a continuum and the differentiation between PPE and empyema relies significantly on pleural fluid biochemistry and microbiology.27, 28 Thus, only those children who had an invasive

References (32)

  • F.J. McLaughlin et al.

    Empyema in children: clinical course and long-term follow-up

    Pediatrics

    (1984)
  • G.J. Redding et al.

    Lung function in children following empyema

    Am J Dis Child

    (1990)
  • B. Satish et al.

    Management of thoracic empyema in childhood: does the pleural thickening matter?

    Arch Dis Child

    (2003)
  • I.M. Balfour-Lynn et al.

    BTS guidelines for the management of pleural infection in children

    Thorax

    (2005)
  • M. Proesmans et al.

    Clinical practice: treatment of childhood empyema

    Eur J Pediatr

    (2009)
  • E. Yilmaz et al.

    Parapneumonic empyema in children: conservative approach

    Turk J Pediatr

    (2002)

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