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Published on: February 23, 2014
Paediatric empyema: worsening disease severity and challenges identifying patients at increased risk of repeat
Stuart Haggie1, Hasantha Gunasekera2, Chetan Pandit3
1Children's Hospital at Westmead, Westmead, New South Wales, Australia stuart.haggie@gmail.com.
Insights
Pediatric empyema incidence is rising. Chest drainage and fibrinolytic therapy (CDF) has a 28% reintervention rate, while video-assisted thoracoscopic surgery (VATS) has a 6% rate. Continued fever post-intervention predicts repeat procedures.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Infectious Diseases
Background:
- Empyema, a common pneumonia complication, requires prompt intervention.
- Primary treatments include chest drainage and fibrinolytic therapy (CDF) or video-assisted thoracoscopic surgery (VATS).
- Understanding disease trends and treatment outcomes is crucial for optimizing pediatric empyema management.
Purpose of the Study:
- To describe trends in pediatric empyema incidence and severity.
- To analyze clinical outcomes and identify factors associated with reintervention.
- To compare the effectiveness of CDF versus VATS in pediatric empyema.
Main Methods:
- Retrospective cohort study of pediatric empyema cases (2011-2018).
- Inclusion criteria: cases requiring drainage or surgical intervention at a tertiary children's hospital.
- Data analysis included incidence rates, intervention types, patient demographics, pathogen detection, and reintervention rates.
Main Results:
- Empyema incidence increased significantly from 1.7 to 7.1 per 1000 admissions.
- A total of 192 cases were analyzed: 174 (90%) received CDF and 18 (10%) underwent VATS.
- Reintervention rates were 28% for CDF and 6% for VATS. Continued fever post-intervention was a significant predictor of repeat procedures (OR 1.3).
- Common pathogens included *Streptococcus pneumoniae* (39%) and *S. aureus* (13%).
Conclusions:
- Pediatric empyema incidence and severity are increasing.
- CDF is associated with a higher reintervention rate compared to VATS.
- Predicting initial treatment failure based on presentation variables or early investigations remains challenging.
Objective:
Empyema is the most common complication of pneumonia. Primary interventions include chest drainage and fibrinolytic therapy (CDF) or video-assisted thoracoscopic surgery (VATS). We describe disease trends, clinical outcomes and factors associated with reintervention.
Design/Setting/Patients:
Retrospective cohort of paediatric empyema cases requiring drainage or surgical intervention, 2011-2018, admitted to a large Australian tertiary children's hospital.
Results:
During the study, the incidence of empyema increased from 1.7/1000 to 7.1/1000 admissions (p<0.001). We describe 192 cases (174 CDF and 18 VATS), median age 3.0 years (IQR 1-5), mean fever duration prior to intervention 6.2 days (SD ±3.3 days) and 50 (26%) cases admitted to PICU. PICU admission increased during the study from 18% to 34% (p<0.001). Bacteraemia occurred in 23/192 (12%) cases. A pathogen was detected in 131/192 (68%); Streptococcus pneumoniae 75/192 (39%), S. aureus 25/192 (13%) and group A streptococcus 13/192 (7%). Reintervention occurred in 49/174 (28%) and 1/18 (6%) following primary CDF and VATS. Comparing repeat intervention with single intervention cases, a continued fever postintervention increased the likelihood for a repeat intervention (OR 1.3 per day febrile; 95% CI 1.2 to 1.4, p<0.0001). Younger age, prolonged fever preintervention and previous antibiotic treatment were not associated with initial treatment failure (all p>0.05).
Conclusion:
We report increasing incidence and severity of empyema in a large tertiary hospital. One in four patients required a repeat intervention after CDF. Neither clinical variables at presentation nor early investigations were able to predict initial treatment failure.
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