Parapneumonic Effusion and Empyema in Children: Retrospective Review of the duPont Experience

Management of pediatric parapneumonic effusions and empyema remains controversial. Treatment includes antibiotics, chest tube, fibrinolytic therapy, video-assisted thoracoscopy and debridement, and open thoracotomy and decortication. A retrospective 10-year study was done to identify patient selecti...

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Bibliographic Details
Published in:Clinical Pediatrics 2007-07, Vol.46 (6), p.518-522
Main Authors: Padman, Raj, King, Katherine A., Iqbal, Sahir, Wolfson, Philip J.
Format: Article
Language:English
Subjects:
Child
Child, Preschool
Children & youth
Delaware
Empyema, Pleural - etiology
Empyema, Pleural - therapy
Female
Humans
Length of Stay - statistics & numerical data
Longitudinal Studies
Lungs
Male
Medical treatment
Pediatrics
Pleural Effusion - etiology
Pleural Effusion - therapy
Pneumonia
Pneumonia - complications
Respiratory diseases
Retrospective Studies
Statistics, Nonparametric
Thoracic Surgery, Video-Assisted - methods
Treatment Outcome
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Summary:Management of pediatric parapneumonic effusions and empyema remains controversial. Treatment includes antibiotics, chest tube, fibrinolytic therapy, video-assisted thoracoscopy and debridement, and open thoracotomy and decortication. A retrospective 10-year study was done to identify patient selection variables for specific therapies. Charts (n = 101) with diagnoses of empyema without comorbidity were reviewed, a database was developed, and variables between patients who did and did not receive thoracoscopic debridement were compared at admission and during hospitalization. The difference in positive culture reports with video-assisted thoracoscopy compared with medical management was significant (P < .018). Postsurgical patients used the intensive care unit and had 2 or more chest tubes with greater frequency than medically managed patients (P < .014, P < .002). Antibiotics, video-assisted thoracoscopy, and chest tube within 48 hours of admission shortened hospitalization by 4 days (P < .001) compared with delayed video-assisted thoracoscopy done after 48 hours of admission.
ISSN:0009-9228
1938-2707
DOI:10.1177/0009922806299096