Postpneumonic empyema in childhood: selecting appropriate therapy.
In order to identify appropriate treatment options for postpneumonic empyema, we reviewed the medical records and, when possible, obtained long-term follow-up chest radiographs and pulmonary function tests on children treated for empyema during the past 11 years. Fifty-one patients were treated in various ways, with antibiotics alone (N = 10), or in combination with tube thoracostomy (N = 23) or decortication (N = 18). Despite administration of appropriate antibiotics and establishment of pleural drainage, many children required prolonged hospitalization and eventual decortication. Based on this review, a scoring system was developed allowing early classification by severity of pleural disease. Factors found to be predictors of severe pleural disease include (1) low pleural fluid pH or (2) glucose; (3) presence of moderate or severe scoliosis or (4) pleural peel or parenchymal entrapment by chest radiography; and (5) infection due to anaerobes, gram-negative organisms, or mycoplasma. Complete opacification of a hemithorax on chest radiography and a pleural peel to thoracic ratio greater than 40% were also associated with severe pleural disease. In patients with mild disease (N = 7), response to antibiotics alone, rapid resolution of fever, and shorter hospital stays were observed. In patients with more severe infections (moderate = 22, severe = 22), decortication accomplished earlier defervescence, radiographic improvement, and hospital discharge than simple tube thoracostomy. No deaths or morbidity were associated with decortication, which could often be accomplished through a minithoracotomy. Follow-up chest radiographs and pulmonary fuction tests showed a prompt return to normal after decortication. This experience indicates utility of a pleural disease severity scoring system in selection of treatment options for children with postpneumonic empyema.(ABSTRACT TRUNCATED AT 250 WORDS)
Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN.
S J
SJ
Hoff
W W
WW
Neblett
R M
RM
Heller
J B
JB
Pietsch
G W
GW
Holcomb
J R
JR
Sheller
T W
TW
Harmon
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004653:Empyema / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D008168:Lung / Q000601:surgery; D008297:Male; D011014:Pneumonia / Q000150:complications*; D012189:Retrospective Studies