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Clinical experience of managing empyema thoracic in children
Fang-Liang Huang1, Po-Yen Chen, Jui-Shan Ma
1Department of Pediatrics, Taichung Veterans General Hospital, Taiwan, ROC.
Insights
Pediatric thoracic empyema management improved with decortication, leading to faster fever reduction and no complications. This surgical approach offers a safe and effective treatment for children with loculated empyema thoracis.
Area of Science:
- Pediatric Surgery
- Thoracic Medicine
- Infectious Diseases
Background:
- Thoracic empyema is a significant pediatric infection.
- Common pathogens include Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae.
Purpose of the Study:
- To compare the efficacy and safety of antibiotics with tube thoracostomy versus pleural decortication for treating pediatric thoracic empyema.
Main Methods:
- Retrospective analysis of 54 children diagnosed with thoracic empyema.
- Patients were divided into two groups: antibiotic/tube thoracostomy and antibiotic/decortication.
- Outcomes measured included defervescence time and complication rates.
Main Results:
- Decortication resulted in significantly faster defervescence (1.94 days) compared to tube thoracostomy (5.04 days).
- No complications were reported in the decortication group, whereas complications were noted in the tube thoracostomy group (p<0.03).
- Streptococcus pneumoniae was the most frequent pathogen identified.
Conclusions:
- Pleural decortication is a safe and effective management procedure for loculated empyema thoracis in children.
- Decortication offers superior outcomes in terms of fever resolution compared to closed tube thoracostomy.
- This surgical intervention is recommended for complex pediatric empyema cases.
Abstract:
Data of 54 children with a diagnosis of thoracic empyema at a medical center in central Taiwan from January 1991 through April 2001 were analyzed. Their mean age was 4.4 years and the mean hospital stay was 13 days. Streptococcus pneumoniae was the most common pathogen, followed by Staphylococcus aureus and Haemophilus influenzae. These patients were divided into 2 groups according to the treatment method. Twenty-two patients were treated successfully with antibiotics and tube thoracostomy, whereas the other 32 children required further pleural decortication with antibiotic treatment. In patients with empyema, decortication allowed for more rapid defervescence than did closed tube thoracostomy (1.94 vs 5.04 days; p<0.001) and there were no complications in the group that underwent decortication treatment (p<0.03). In conclusion, the decortication of loculated empyema thoracis in children is a safe and effective management procedure.