title: Parapneumonic empyema in children: decortication hastens recovery in patients with severe pleural infections.
abstract: The medical records of 61 children 0 to 18 years of age treated for empyema complicating pneumonia from 1977 to 1989 were reviewed with attention to clinical presentation, bacteriology, treatment and outcome. Streptococcus pneumoniae was the most common infecting organism, followed by Staphylococcus aureus, other streptococcal species, anaerobes, Haemophilus influenzae type b, Pseudomonas aeruginosa, and Eikenella corrodens. No organisms were recovered in 39% of patients. Twelve patients were treated successfully with antibiotics and thoracentesis alone, 23 patients underwent close tube thoracostomy and 26 required decortication. A thickened pleural "peel," scoliosis and opacification of a hemithorax on chest radiograph, as well as low pleural pH and glucose concentration, were associated with a poor response to medical management. A scoring system was developed to define the severity of pleural disease. In patients with severe pleural infections, decortication allowed more rapid defervescence (2.2 vs. 6.5 days) and earlier hospital discharge (4.4 vs. 12.4 days) than did closed tube thoracostomy (P less than 0.001).
authors.affiliation: Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN 37212.
authors.forename: S J
authors.initials: SJ
authors.lastname: Hoff
authors.forename: W W
authors.initials: WW
authors.lastname: Neblett
authors.forename: K M
authors.initials: KM
authors.lastname: Edwards
authors.forename: R M
authors.initials: RM
authors.lastname: Heller
authors.forename: J B
authors.initials: JB
authors.lastname: Pietsch
authors.forename: G W
authors.initials: GW
authors.lastname: Holcomb
authors.forename: G W
authors.initials: GW
authors.lastname: Holcomb
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015505:Chest Tubes; D002648:Child; D002675:Child, Preschool; D004653:Empyema / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007239:Infections / Q000209:etiology; D008297:Male; D010996:Pleural Effusion / Q000209:etiology; D011014:Pneumonia / Q000150:complications; D011859:Radiography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013907:Thoracostomy / Q000009:adverse effects; D013908:Thoracotomy
chemical_list: D000900:Anti-Bacterial Agents