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Thoracoscopy in pediatric pleural empyema: a prospective study of prognostic factors

Nicolas Kalfa1, Hossein Allal, Manuel Lopez

  • 1Visceral Pediatric Surgery Department, Lapeyronie-Arnaud de Villeneuve Hospital, Montpellier Cedex 5 34295, France.

Journal of Pediatric Surgery
|October 3, 2006
PubMed

Insights

Delaying thoracoscopy for pleural empyema beyond four days increases surgical difficulties and complications. Early surgical intervention is crucial for better outcomes in pediatric pleural empyema cases.

Area of Science:

  • Pediatric Thoracic Surgery
  • Pulmonology
  • Infectious Diseases

Background:

  • Indications for thoracoscopy in pediatric pleural empyema are not well-defined.
  • Identifying preoperative prognostic factors can aid surgical decision-making.

Purpose of the Study:

  • To identify preoperative prognostic factors for thoracoscopic treatment of pediatric pleural empyema.
  • To improve surgical decision-making in these cases.

Main Methods:

  • Retrospective analysis of 50 children with parapneumonic pleural empyema undergoing thoracoscopy.
  • Evaluation of clinical, bacteriological, and ultrasonographic data, as well as delay to surgery.
  • Multivariate analysis to determine prognostic value of various factors.

Main Results:

  • Clinical and bacteriological data did not significantly predict postoperative outcomes.
  • Ultrasonographic findings like echogenicity and loculations were not independent prognostic factors.
  • A delay of over 4 days between diagnosis and surgery correlated with increased surgical difficulties, longer hospitalization, and more complications.

Conclusions:

  • The interval between diagnosis and surgery is the primary prognostic factor for thoracoscopic treatment of pleural empyema.
  • A delay exceeding 4 days is associated with poorer outcomes.
  • Ultrasonography alone is insufficient for predicting the postoperative course.
Abstract

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