Source: Annual Congress 2002 - Empyema thoracis in children
Disease area: Respiratory infections

Abstract

Background: The most appropriate surgical therapy for parapneumonic effusion and empyema remains controversial.
Aim: To examine the effect of surgical interventions on short-term outcome of parapneumonic effusions in a single, tertiary, children's centre.
Method: Retrospective analysis of case notes of 48 children admitted between January 1998 and March 2001.
Results: Median (range) age was 5y 2m (18d to 15y 2m). Median duration of symptoms was 9 days (1 to 39d), and duration of admission prior to surgery 3 days (0 to 34d). Ultrasound was performed in 46 children (96%) and loculations were present in 31 (65%). Positive microbiology was found in 15 children (32%). Intravenous antibiotics were given for median of 6 days (1 to 23d), and oral antibiotics for 21.5 days (0 to 64d). A surgical procedure was performed in 46 children (96%) on median day 2, (chest drain alone in 8 (17%); chest drain and intrapleural fibrinolytic therapy in 14 (29%); thoracotomy with pleural debridement in 24 (50%)). Six children returned to theatre for thoracotomy (3 after chest drain alone, 2 after fibrinolytic therapy, and 1 after initial thoracotomy). The median length of stay was 7 days (1 to 59d). Thoracotomy was associated with the shortest median [IQR] length of stay (6.5d [5-9d]) compared with chest drain alone (15d [6-20d], p=0.033), and fibrinolytic therapy (8d [6-12d], p=0.07). Stay after surgery was also shortest following thoracotomy (6d [5-7d]) compared with chest drain alone (13d [5-19d], p=0.024), and fibrinolytic therapy (7.5d [6-10d], p=0.07).
Conclusions: Thoracotomy was associated with a shorter length of stay. Chest drain alone was associated with a prolonged stay and a high rate of return to theatre. Fibrinolytic therapy appeared to be an effective additional therapy.

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Citations should be made in the following way:
T. N. Hilliard, S. C. Langton Hewer, J. Henderson (Bristol, United Kingdom). Management of parapneumonic effusion and empyema in children. Eur Respir J 2002; 20: Suppl. 38, 3690

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