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[Pleural effusion and complicated empyema in children. Evolution and prognostic factors]
1Sección Respiratorio Pediátrico, Departamento de Pediatría, y Radiología, Sección de Cirugía Pediátrica, División de Cirugía, Pontificia Universidad Católica de Chile, Lira 44-1er piso, Casilla 114-D Santiago, Chile.
Insights
This study found no reliable clinical, radiological, or pleural fluid markers to predict which pediatric patients with complicated empyema will need surgery. Further research is needed to identify predictive factors for surgical intervention.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Infectious Diseases
Background:
- Complicated pleural empyema in children often has a prolonged clinical course.
- Surgical intervention is sometimes necessary, but predictive factors remain unclear.
Purpose of the Study:
- To identify clinical, laboratory, or radiological predictors for surgical treatment in pediatric patients with empyema.
- To improve the management of complicated pleural empyema.
Main Methods:
- Retrospective chart review of 108 pediatric patients with pneumonia and pleural effusion.
- Analysis of clinical data, laboratory results, and radiological findings (ultrasonography).
- Comparison between surgically and medically treated empyema patients.
Main Results:
- Of 49 empyema cases, 13 required surgery. No significant differences were found in fever duration, hospital stay, pleural fluid pH, or glucose levels between groups.
- Pleural fluid cultures were positive in 21/79 patients, with Streptococcus pneumoniae being the most common pathogen.
- No differences observed in risk factors, effusion characteristics, or positive Gram stain/cultures between surgical and medical groups.
Conclusions:
- This study did not identify any predictive clinical, radiological, or pleural fluid parameters for surgical treatment requirement in pediatric empyema.
- The findings highlight the need for further investigation into predictive factors for surgical intervention in pediatric empyema.
Background:
Complicated pleural empyema has a torpid and longer clinical evolution, requiring in some patients surgical management. The predictive factors for surgical treatment are not well known.
Aim:
To search for clinical, laboratory or radiological predictors for the requirement of surgical treatment in pediatric patients with empyema.
Patients And Methods:
A retrospective review of the charts of 108 patients hospitalized for pneumonia plus pleural effusion at the Pediatric Service of the Catholic University Hospital between January 1985 and July 2000.
Results:
Eighty one patients had complete radiological evaluation and pleural fluid biochemical analysis. Forty nine (60%) fulfilled the criteria for empyema and 32 (40%) for an exudate. Thirteen patients with empyema required surgery and 36 were treated medically. The mean age was 3 years (range 9 months-6 years) for the surgically treated and 4 years (range 12 months-14 years) for the non-surgical group. The male/female ratio was 5:1 in the surgical group and 1:1 for the non-surgical group. Pleural fluid cultures were positive in 21 of 79 patients. Streptococcus pneumonia was the most frequently isolated agent. No significant differences were found between groups for the average days of fever prior to the diagnosis or total days of fever, days of hospital stay, pleural fluid pH (6.8 and 7.0 respectively) and glucose (21 and 31 mg/dl respectively). No differences were either observed for pleural fluid risk factors (pH < 7 and glucose < 20 mgdl), the presence of extensive pleural effusions, pleural loculations or bands on pleural ultrasonography and positive Gram stain or cultures in the pleural fluid. Surgical patients required oxygen for more days than medical patients (7.7 and 5.1 days; p = 0.037).
Conclusions:
This study failed to find predictive clinical, radiological or pleural fluid parameters, for the requirement of surgical treatment of empyema.