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The rising incidence of pediatric empyema with fistula
T K Pandian1, Johnathon M Aho2, Daniel S Ubl3
1Division of Subspecialty General Surgery, Mayo Clinic Department of Surgery, 200 First Street SW, Rochester, MN, 55905, USA. pandian.twinkle@mayo.edu.
Insights
The incidence of empyema with fistula (EWF) in children increased from 2000 to 2009. This study analyzed national data to understand the epidemiology and diagnoses of pediatric EWF.
Area of Science:
- Pediatric Pulmonology
- Epidemiology
- Thoracic Surgery
Background:
- Empyema with fistula (EWF) in children is a serious condition with unknown incidence and etiology.
- Understanding the epidemiology of pediatric EWF is crucial for diagnosis and treatment.
Purpose of the Study:
- To define the epidemiology and associated diagnoses of empyema with fistula (EWF) in children.
- To analyze national database for pediatric EWF trends.
Main Methods:
- Utilized Kids' Inpatient Database (2000-2012) for children with EWF (ICD-9 code 510.0).
- Evaluated patient characteristics, institutional data, and comorbidities.
- Calculated weighted national estimates and compared incidence rates across years using Rao-Scott Chi Square test.
Main Results:
- 908 pediatric hospitalizations for EWF identified between 2000-2012.
- Incidence of EWF significantly increased from 2000 to 2009 (p < 0.01).
- Pneumonia/pulmonary abscess and EWF were common primary diagnoses; pleural space manipulation was frequent.
Conclusions:
- The study reveals a rising incidence of pediatric EWF between 2000-2009.
- Bronchopleural fistulae are likely the primary cause of EWF in this pediatric cohort.
- Further multi-institutional studies are necessary to confirm etiology and outcomes.
Purpose:
The incidence and etiology of empyema with fistula (EWF) in children is unknown. We analyzed a national database to define the epidemiology and diagnoses associated with this condition.
Methods:
Discharge data from the Kids' Inpatient Database were reviewed for EWF (ICD-9 diagnosis code 510.0) in children ≤18 years from 2000 to 2012. Patient characteristics, institutional data, and accompanying conditions were evaluated. Weighted national estimates were calculated and incidence compared across years (2000, 2003, 2006, 2009) using the Rao-Scott Chi Square.
Results:
From 2000 to 2012, 908 children were hospitalized with EWF. Age distribution was bimodal. Common primary diagnoses related to the hospitalization were pneumonia/pulmonary abscess (31.2 %) and EWF (19.3 %). Manipulation of the pleural space (e.g. decortication, drainage) comprised 45.0 % of procedures. Incidence rates of EWF increased (Rao Scott Adjusted Chi Square: 16.13, p < 0.01) over the study period. Although not statistically significant, median length of stay and age of diagnosis decreased and increased, respectively.
Conclusion:
This first, national pediatric EWF study reveals rising incidence during the years 2000-2009. Despite limitations in ICD-9 coding, concomitant primary diagnoses and procedures suggest bronchopleural fistulae likely represent the vast majority of cases in this cohort. Multi-institutional studies are needed to confirm etiology and characterize outcome of EWF.
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