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Rational treatment of empyema in children

A H Meier1, B Smith, A Raghavan

  • 1Division of Pediatric Surgery, Stanford University, 725 Welch Rd, Palo Alto, CA 94304, USA.

Archives of Surgery (Chicago, Ill. : 1960)
|August 2, 2000
PubMed

Insights

Pediatric empyema treatment is effective and cost-efficient using thoracostomy tube drainage (TTD) with or without fibrinolytic therapy (FT). Advanced cases may benefit from video-assisted thoracoscopic debridement (VATD), with imaging guiding treatment decisions.

Area of Science:

  • Pediatric Pulmonology
  • Thoracic Surgery
  • Medical Imaging

Background:

  • Pediatric empyema requires effective and cost-efficient treatment strategies.
  • Current therapeutic options include thoracostomy tube drainage (TTD) with or without fibrinolytic therapy (FT), and video-assisted thoracoscopic debridement (VATD).

Purpose of the Study:

  • To evaluate the efficacy and cost-effectiveness of different treatment protocols for pediatric empyema based on radiographic appearance.
  • To determine the optimal timing and modality for intervention in pediatric empyema cases.

Main Methods:

  • Retrospective case series conducted at a tertiary referral center.
  • Analysis of 31 children treated between 1995 and 1999.
  • Comparison of outcomes and costs for TTD (with or without FT) versus VATD.

Main Results:

  • TTD with or without FT was successful in most pediatric empyema cases (85.2%).
  • Salvage VATD was required in 14.8% of TTD cases, with higher associated costs and length of stay.
  • Primary VATD was performed in 12.9% of cases, demonstrating shorter hospital stays and lower overall charges compared to salvage VATD.
  • Complications were minimal, with no significant adverse events related to urokinase therapy.

Conclusions:

  • TTD with or without FT is a safe and effective first-line treatment for early-stage pediatric empyema.
  • Primary VATD is recommended for children with advanced disease.
  • An algorithmic approach utilizing imaging (CT or ultrasonography) can improve prediction of treatment failure and optimize cost-effectiveness.
Abstract

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