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Scoring system for empyema thoracis and help in management
1Department of Pediatrics, Chang Gung Children's Hospital, Taiwan. pchest@adm.cgmh.org.tw
Indian Journal of Pediatrics
|January 3, 2006
Summary
A low pleural pH and a new empyema severity score predict the need for surgery in children. Early video-assisted thoracoscopic surgery (VATS) can shorten hospital stays for pediatric empyema patients.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Infectious Diseases
Background:
- Empyema in children requires effective management strategies.
- Predicting surgical intervention is crucial for optimal patient outcomes.
Purpose of the Study:
- To assess a new empyema severity score for predicting surgical management in pediatric patients.
- To compare hospitalization duration between medical therapy, salvage VATS, and early VATS.
Main Methods:
- Retrospective chart review of pediatric empyema patients (1993-2002).
- Categorization into medical, salvage VATS, and early VATS groups.
- Comparison of demographic, clinical, and laboratory data using an empyema severity score (SSE).
Main Results:
- Streptococcus pneumoniae was the most common pathogen; 39% of cases had no recovered organisms.
- A pleural pH < 7.1 increased the odds of surgical intervention by sixfold.
- Children requiring decortication had higher severity scores (mean 4.8 vs 3.0).
- Early VATS resulted in shorter hospital stays (18 days) compared to salvage VATS (28 days).
Conclusions:
- Pleural pH < 7.1 and an empyema severity score of 4 predict surgical intervention for fibrinopurulent empyema.
- Early elective VATS, within 7 days of failed medical therapy, can reduce length of stay and morbidity.