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Outcomes associated with type of intervention and timing in complex pediatric empyema
Adam B Goldin1, Chinnaya Parimi1, Cabrini LaRiviere1
1Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Department of Surgery, University of Washington, 4800 Sand Point Way NE, M/S W-7729, PO Box 5371, Seattle, WA 98105, USA.
Insights
Pediatric effusion/empyema treatment complexity is high. Antibiotics alone are effective for many children, but timely intervention is crucial to avoid higher mortality risks.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Infectious Diseases
Background:
- Pediatric pneumonia with effusion/empyema complicates treatment, often necessitating pleural drainage.
- Current evidence lacks guidance on optimal drainage modalities for children.
Purpose of the Study:
- To evaluate treatment outcomes for pediatric effusion/empyema.
- To compare the effectiveness of different pleural drainage strategies.
Main Methods:
- Retrospective cohort study.
- Utilized the Pediatric Health Information System database (2003-2008).
- Analyzed data from 14,936 children hospitalized with effusion/empyema.
Main Results:
- 52% of children received antibiotics alone.
- Antibiotics alone, thoracotomy, and video-assisted thoracoscopic surgery (VATS) showed shorter length of stay, lower mortality, and fewer re-interventions compared to chest tubes.
- Delaying drainage by 1-3 days correlated with lower mortality; delays >7 days increased mortality.
Conclusions:
- Antibiotics alone are successful for nearly half of pediatric effusion/empyema cases with low morbidity/mortality.
- Initial VATS or thoracotomy demonstrated superior outcomes.
- Drainage intervention should not be delayed beyond 7 days.
Background:
The presence of effusion/empyema in pediatric pneumonia can increase treatment complexity by possibly requiring pleural drainage. Currently, no data support the superiority of any drainage modalities in children.
Methods:
We performed a retrospective cohort study using the Pediatric Health Information System database from 2003 to 2008.
Results:
A total of 14,936 children were hospitalized with effusion/empyema. Fifty-two percent of children were treated with antibiotics alone. Compared with patients receiving a chest tube, patients receiving antibiotics alone, thoracotomy, and video-assisted thoracoscopic surgery had a shorter length of stay, lower mortality rates, and fewer re-interventions. Delaying drainage by 1 to 3 days was associated with a lower mortality rate, and a delay of more than 7 days was associated with a higher mortality rate.
Conclusions:
Half of all children with effusion/empyema are treated with antibiotics alone with low morbidity and mortality. Initial video-assisted thoracoscopic surgery or thoracotomy had improved outcomes compared with other interventions. Intervention should not be delayed beyond 7 days.
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