Management of children with empyema: Pleural drainage is not always necessary†‡

  1. Edward Carter MD1,*,
  2. John Waldhausen MD2,
  3. Weiya Zhang MD3,
  4. Lucas Hoffman MD, PhD1,
  5. Gregory Redding MD1

Article first published online: 2 APR 2010

DOI: 10.1002/ppul.21200

Issue

Pediatric Pulmonology

Pediatric Pulmonology

Volume 45, Issue 5, pages 475–480, May 2010

Additional Information

How to Cite

Carter, E., Waldhausen, J., Zhang, W., Hoffman, L. and Redding, G. (2010), Management of children with empyema: Pleural drainage is not always necessary. Pediatric Pulmonology, 45: 475–480. doi: 10.1002/ppul.21200

Author Information

  1. 1

    Department of Pediatrics, University of Washington, Seattle, Washington

  2. 2

    Department of Surgery, University of Washington, Seattle, Washington

  3. 3

    School of Medicine, University of Washington, Seattle, Washington

*Seattle Children's Hospital, 4800 Sand Point Way NE, Mailstop 5937, Seattle, WA 98105.

  1. †

    No financial interests to disclose by any of the authors concerning this manuscript.

  2. ‡

    Presented in part at the International Meetings of the American College of Chest Physicians, Salt Lake City UT, October 2006, and San Diego CA, November 2009.

Publication History

  1. Issue published online: 21 APR 2010
  2. Article first published online: 2 APR 2010
  3. Manuscript Accepted: 29 NOV 2009
  4. Manuscript Revised: 28 NOV 2009
  5. Manuscript Received: 3 OCT 2009

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Keywords:

  • children;
  • empyema;
  • pneumonia;
  • pleural effusion

Abstract

Background

There is considerable variation in the management of pediatric empyema, and there are no clear criteria for when to perform pleural drainage. Our study aims were: (1) to retrospectively review our experience with an empyema treatment strategy that started with intravenously administered (IV) antibiotics alone in medically stable patients with procession to pleural drainage only if there was no clinical improvement after 48 hr, and (2) to identify predictors for undergoing pleural drainage.

Methods

We performed a retrospective review of 182 previously healthy children, 1–18 years old, hospitalized with empyema from December 1996 through December 2008. The primary outcome measures were the proportion of patients requiring pleural drainage procedures and hospital length of stay (LOS).

Results

Ninety-five children (52%) received antibiotics alone, and 87 (45%) underwent drainage procedures (21 chest tube alone, 57 VATS/thoracotomy, and 8 chest tube followed by VATS/thoracotomy); only 4 received fibrinolytics. Mean (standard deviation) LOS was significantly shorter in the antibiotics alone group, 7.0 (3.5) versus 11 (4.0) days. The strongest predictors of undergoing pleural drainage were admission to the intensive care unit and large effusion size (>½ thorax filled).

Conclusions

Some children with empyema can be treated with IV antibiotics alone and have reasonably short LOS. At our institution, those that required intensive care or had large effusions with mediastinal shift were more likely to require pleural drainage. Pediatr Pulmonol. 2010; 45:475–480. © 2010 Wiley-Liss, Inc.

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