Pediatric empyemas - Has the pendulum swung too far?

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.