Development of parapneumonic empyema in children.
OBJECTIVE
The aim of the study was to find clinical predictors for parapneumonic empyema in children.


METHODS
Thirty-seven children treated for parapneumonic empyema at the Department of Pediatrics, Turku University Hospital, were retrospectively evaluated. Two distinct comparison groups of children with uncomplicated community-acquired pneumonia with alveolar consolidation (n = 37 in both groups) were included. Clinical and laboratory data on admission as well as fever kinetics and inflammatory markers during hospitalization were analyzed.


RESULTS
In a multivariate analysis, a history of prolonged fever, tachypnoea and pain on abdominal palpation on admission were the most significant clinical predictors for empyema. On admission, serum C-reactive protein levels were higher among children with empyema than among those with uncomplicated pneumonia (means, 234 mg/L vs. 178 mg/L; p = 0.037). During hospitalization, prolonged fever and persistence of high serum C-reactive protein levels were associated with empyema. At the initial evaluation, pleural fluid was not reported in 35% of children with empyema.


CONCLUSIONS
Early recognition of developing empyema is challenging. Children with pneumonia presenting with prolonged fever, tachypnoea, pain on abdominal palpation and high serum C-reactive protein levels are at risk for parapneumonic empyema.
Lahti
Elina
E
Department of Pediatrics, Turku University Hospital, Turku, Finland. elkrla@utu.fi
Peltola
Ville
V
Virkki
Raimo
R
Alanen
Markku
M
Ruuskanen
Olli
O
D000293:Adolescent; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D003937:Diagnosis, Differential; D018450:Disease Progression; D016724:Empyema, Pleural / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008499:Medical Records; D015999:Multivariate Analysis; D018410:Pneumonia, Bacterial / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors
D002097:C-Reactive Protein