title: Parapneumonic effusion and empyema in children: retrospective review of the duPont experience.
abstract: Management of pediatric parapneumonic effusions and empyema remains controversial. Treatment includes antibiotics, chest tube, fibrinolytic therapy, video-assisted thoracoscopy and debridement, and open thoracotomy and decortication. A retrospective 10-year study was done to identify patient selection variables for specific therapies. Charts (n = 101) with diagnoses of empyema without comorbidity were reviewed, a database was developed, and variables between patients who did and did not receive thoracoscopic debridement were compared at admission and during hospitalization. The difference in positive culture reports with video-assisted thoracoscopy compared with medical management was significant (P < .018). Postsurgical patients used the intensive care unit and had 2 or more chest tubes with greater frequency than medically managed patients (P < .014, P < .002). Antibiotics, video-assisted thoracoscopy, and chest tube within 48 hours of admission shortened hospitalization by 4 days (P < .001) compared with delayed video-assisted thoracoscopy done after 48 hours of admission.
authors.affiliation: Division of Pulmonary, Alfred I. duPont Hospital for Children, Nemours Children's Clinic, Wilmington, DE 19899, USA. rpadman@nemours.org
authors.forename: Raj
authors.initials: R
authors.lastname: Padman
authors.forename: Katherine A
authors.initials: KA
authors.lastname: King
authors.forename: Sahir
authors.initials: S
authors.lastname: Iqbal
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Wolfson
mesh_terms: D002648:Child; D002675:Child, Preschool; D003691:Delaware; D016724:Empyema, Pleural / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D010996:Pleural Effusion / Q000209:etiology / Q000628:therapy*; D011014:Pneumonia / Q000150:complications; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D016896:Treatment Outcome