Adam B Goldin1, Chinnaya Parimi2, Cabrini LaRiviere2, Michelle M Garrison3, Cindy L Larison3, Robert S Sawin2. 1. Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Department of Surgery, University of Washington, 4800 Sand Point Way NE, M/S W-7729, PO Box 5371, Seattle, WA 98105, USA. Electronic address: adam.goldin@seattlechildrens.org. 2. Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Department of Surgery, University of Washington, 4800 Sand Point Way NE, M/S W-7729, PO Box 5371, Seattle, WA 98105, USA. 3. Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA.
Abstract
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.
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.
Authors: Morgan K Richards; Jarod P Mcateer; Todd C Edwards; Lucas R Hoffman; Matthew P Kronman; Dennis W Shaw; Adam B Goldin Journal: Surg Infect (Larchmt) Date: 2016-11-29 Impact factor: 2.150