Outcomes associated with type of intervention and timing in complex pediatric empyema

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 Pediatr...

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Bibliographic Details
Published in:The American journal of surgery 2012-05, Vol.203 (5), p.665-673
Main Authors: Goldin, Adam B., M.D., M.P.H, Parimi, Chinnaya, M.D, LaRiviere, Cabrini, M.D., M.P.H, Garrison, Michelle M., Ph.D, Larison, Cindy L., M.A, Sawin, Robert S., M.D., M.S
Format: Article
Language:English
Subjects:
Adolescent
Bacterial diseases
Bacterial diseases of the respiratory system
Biological and medical sciences
Child
Child, Preschool
Cohort Studies
Effectiveness
Empyema
Empyema, Pleural - surgery
Empyema, Pleural - therapy
Female
Fistula
General aspects
Human bacterial diseases
Humans
Infant
Infectious diseases
Length of stay
Male
Medical sciences
Mortality
Ostomy
Pleural effusion
Pneumology
Respiratory system : syndromes and miscellaneous diseases
Retrospective Studies
Surgery
Thoracentesis
Thrombolytic therapy
Time Factors
Treatment Outcome
Video-assisted thoracic surgery
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Summary: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.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2012.01.005