Empyema thoracis in children: clinical presentation, management and complications
Ali Faisal Saleem1, Abdul Sattar Shaikh1, Reema Sajjad Khan1
1Department of Pediatrics and Child Health, The Aga Khan University Hospital, Karachi.
Insights
This study found Staphylococcus aureus to be the primary cause of pediatric empyema thoracis. Early antibiotic treatment and surgical intervention for younger, lower-weight children with prolonged fever are crucial for better outcomes.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Thoracic Medicine
Background:
- Empyema thoracis is a significant cause of morbidity in children.
- Understanding the etiology and management is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the causes, clinical presentation, management strategies, and complications of pediatric empyema thoracis.
- To compare medical and surgical management approaches in children.
Main Methods:
- A descriptive, analytical study was conducted on 112 children diagnosed with empyema thoracis.
- Data on demographics, clinical features, management, and complications were collected and analyzed.
- Statistical tests (Mann-Whitney U, chi-square) were used to compare outcomes between medically and surgically managed groups.
Main Results:
- Staphylococcus aureus was the most common pathogen identified.
- The majority of children (59%) were under 5 years old, and 74% were male.
- Children requiring surgery were younger, had lower weight, and experienced longer hospital stays compared to those managed medically.
Conclusions:
- Staphylococcus aureus is the leading cause of pediatric empyema thoracis.
- Prompt diagnosis and appropriate antibiotic therapy are vital for preventing complications.
- Surgical intervention is often necessary for younger, lower-weight children with prolonged fever.
Objective:
To determine the etiology, clinical manifestation, management (medical and surgical) and complications of children with empyema thoracis in a tertiary care hospital from Karachi, Pakistan.
Study Design:
Descriptive, analytical study.
Place And Duration Of Study:
Department of Surgery, The Aga Khan University Hospital, Karachi, from January 1996 to December 2010.
Methodology:
Medical records of admitted children aged > a month to 15 years with discharge diagnosis of empyema thoracis and data was collected on demographic features, clinical manifestation, management and complications. Children managed medically were compared with those managed surgically by using interquartile range and median comparison. Mann-Whitney U test was used to compare age in months, weight (kg) and length of stay in days and presenting complaint, duration of illness; chi-square test was used to compare thrombocytosis in between groups and p-value was calculated.
Results:
Among the 112 patients, 59 (53%) were younger than 5 years of age. Males (n=83, 74%) were predominant. Fifty (45%) children were admitted in winter. Thirty (27%) children found unvaccinated and one fourth (n=27; 24%) were severely malnourished. Fever, cough, and dyspnea were the major presenting symptoms. Sixty-six (59%) were on some antibiotics prior to admission. Staphylococcus aureus (n=13) and Streptococcus pneumoniae (n=5) were the commonest organism isolated from blood and pleural fluid cultures. Majority of the children required some surgical intervention (n=86). Surgically managed children were younger (p=0.01); had less weight (p=0.01) and prolonged fever (p=0.02); and stayed longer in hospital (p < 0.001) as compared to medically managed children. Requiring readmission (n=8), subcutaneous emphysema (n=5) and recollection of pus (n=5) were the major complications.
Conclusion:
Staphylococcus aureus was the major organism associated with paediatric empyema thoracis. Early identification and empiric antibiotic as per local data is essential to prevent short and long-term complications. Younger, lower weight children with prolonged fever required surgical management.
Related Concept Videos
01:27Pneumothorax-II
Clinical Manifestations:
01:26Endoscopic Studies II: Thoracocentesis
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
01:28Esophageal Perforation-II: Clinical Manifestations and Management
Clinical Manifestations:
01:30Pneumonia III: Complications and Assessment
01:28Pleural Effusion II: Symptoms and Management
A pleural effusion is the abnormal collection of fluid between the parietal and visceral pleura layers of tissue that form the lining of the lungs and chest cavity. It can occur independently or due to surrounding parenchymal diseases, such as infection, malignancy, or inflammatory conditions.
Clinical Manifestations:
01:26Pneumothorax-I
Pneumothorax can be even further classified as spontaneous, traumatic, and tension pneumothorax.