Outcomes associated with type of intervention and timing in complex pediatric empyema

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• 作者：Adam B. Goldin ; M.D. ; M.P.H.^a ; ^{adam.goldin@seattlechildrens.org} ; Chinnaya Parimi ; M.D.^a ; Cabrini LaRiviere ; M.D. ; M.P.H.^a ; Michelle M. Garrison ; Ph.D.^b ; Cindy L. Larison ; M.A.^b ; Robert S. Sawin ; M.D. ; M.S.^a
• 关键词：Empyema ; Pleural effusion ; Thrombolytic therapy ; Video-assisted thoracic surgery ; Effectiveness
• 刊名：The American Journal of Surgery
• 出版年：2012
• 期刊代码：9_00029610
• 类别：med
• 出版时间：May, 2012
• 卷：203
• 期：5
• 页码：665-673
• 文件大小：582 K

摘要

Background

The presence of effusion/empyema in pediatric pneumonia can increase treatment complexity by possibly requiring pleural drainage. Currently, no data support the superiority of any drainage modalities in children.

Methods

We performed a retrospective cohort study using the Pediatric Health Information System database from 2003 to 2008.

Results

A total of 14,936 children were hospitalized with effusion/empyema. Fifty-two percent of children were treated with antibiotics alone. Compared with patients receiving a chest tube, patients receiving antibiotics alone, thoracotomy, and video-assisted thoracoscopic surgery had a shorter length of stay, lower mortality rates, and fewer re-interventions. Delaying drainage by 1 to 3 days was associated with a lower mortality rate, and a delay of more than 7 days was associated with a higher mortality rate.

Conclusions

Half of all children with effusion/empyema are treated with antibiotics alone with low morbidity and mortality. Initial video-assisted thoracoscopic surgery or thoracotomy had improved outcomes compared with other interventions. Intervention should not be delayed beyond 7 days.