Related Experiment Video
Updated: Dec 30, 2025
Following in Real Time the Impact of Pneumococcal Virulence Factors in an Acute Mouse Pneumonia Model Using Bioluminescent Bacteria
Published on: February 23, 2014
Pediatric empyemas - Has the pendulum swung too far?
S Christopher Derderian1, Maxene Meier2, David A Partrick1
1Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO.
Insights
Primary video-assisted thoracoscopic surgery (VATS) for childhood empyema leads to shorter hospital stays and less need for mechanical ventilation compared to chest tube and fibrinolytic therapy. This approach offers faster recovery for children with empyema.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Critical Care Medicine
Background:
- Childhood empyema management has shifted towards chest tube and fibrinolytic therapy.
- While effective, this approach can result in prolonged hospitalizations.
Purpose of the Study:
- To compare national trends and outcomes of primary video-assisted thoracoscopic surgery (VATS) versus chest tube and fibrinolytic therapy for childhood empyema.
- To evaluate key metrics including PICU admission, mechanical ventilation, and length of stay.
Main Methods:
- Analysis of the Pediatric Health Information System (PHIS) database from 2010-2017.
- Inclusion of children aged 2 months to 18 years treated for empyema.
- Comparison of outcomes between primary VATS and chest tube/fibrinolysis groups.
Main Results:
- Primary VATS was used in 16% of cases, while chest tube/fibrinolysis was used in 84%.
- Children treated with primary VATS had fewer radiographic studies, lower PICU admission rates, and reduced mechanical ventilation needs.
- Primary VATS also resulted in significantly shorter PICU and overall hospital lengths of stay.
Conclusions:
- Despite current trends favoring chest tube and fibrinolysis, primary VATS demonstrates superior outcomes in terms of resource utilization and patient recovery.
- Further research should focus on identifying children who would benefit most from primary VATS for expedited recovery.
Background:
The management of childhood empyemas has transformed over the past decade, with current trends favoring chest tube placement and intrapleural fibrinolytic therapy. Although this strategy often avoids the need for video-assisted thoracoscopic surgery (VATS), hospital length of stay can be long.
Methods:
To characterize national trends and outcomes associated with empyema management, the Pediatric Health Information System (PHIS) database was queried to identify children (2 months-18 years) treated for an empyema between January 2010 and December 2017. The cohort was divided into those treated with primary VATS and those treated with chest tube and intrapleural fibrinolysis. Number of chest radiographic studies obtained, frequency of pediatric intensive care unit (PICU) admission, mechanical ventilation requirements, and length of hospitalization were compared between groups.
Results:
A total of 3,365 otherwise healthy children met inclusion criteria. Among them, 523 (16%) were managed with primary VATS and 2,842 (84%) were managed with chest tube and fibrinolytic therapy. Of those who were treated with chest tube and fibrinolysis, 193 (6.8%) subsequently underwent VATS. The percentage of children treated with chest tube and fibrinolysis increased from 65% in 2010 to 95% in 2017 (p<0.001). After adjusting for age, race, ethnicity, payer, and region, children who underwent primary VATS received fewer chest radiographic studies, were less likely to be admitted to the PICU or require mechanical ventilation and had a shorter PICU and hospital length of stay compared to those who were treated with chest tube and fibrinolytic therapy (p<0.001 for all analyses).
Discussion:
Although national trends favor chest tube and fibrinolysis, primary VATS are associated with a shorter hospital and PICU length of stay and a lower requirement for mechanical ventilation. Future studies should aim to risk stratify children who may suffer from a protracted course with the goal to offer primary VATS to this subset of children and return them to normal life more expeditiously.
Level Of Evidence:
III.
Related Concept Videos
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:26Tonsillitis II: Management
01:30Pneumonia III: Complications and Assessment
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism