Management of postpneumonic empyemas in children.
OBJECTIVE
The optimal treatment of children with empyema remains controversial. The purpose of this clinical retrospective study was to assess different treatment options in the management of postpneumonic pediatric empyemas.


METHODS
From April 1997 to October 2005, 111 consecutive children (57 boys and 54 girls) were managed for pleural empyema. The mean age was 7.07 years (range: 18 months-14 years). Patients were divided into 3 groups depending on the treatment received: group I, chest tube alone (n = 89); group II, chest tube with fibrinolytics (n = 22); group III, thoracotomy with decortication (n = 19, consisting of 9 patients of group I and 10 of group II with unsuccessful treatment results).


RESULTS
Chest tube alone, chest tube with fibrinolytics, and thoracotomy with decortication had complete response rates of 89.9%, 54.5%, and 100%, respectively. The hospital stay was 11.46 +/- 3.79 days for group I, 9.08 +/- 2.07 days for group II, and 6.32 +/- 2.54 days for group III. There was no statistically significant difference between group I and group II with regard to hospital stay (P = 0.040). Mild pain occurred in 4 children of group II after streptokinase instillation. Only one atelectasis appeared in group III during the postoperative period.


CONCLUSIONS
Chest tube drainage is a safe, effective primary treatment of postpneumonic pediatric empyema. In cases where it is insufficient, thoracotomy with decortication can be used successfully with low morbidity and mortality rates.
Demirhan
R
R
Lutfi Kirdar Kartal Training and Research Hospital, Department of Thoracic Surgery, Erenkoy, Istanbul, Turkey.
Kosar
A
A
Sancakli
I
I
Kiral
H
H
Orki
A
A
Arman
B
B
D000293:Adolescent; D015505:Chest Tubes; D002648:Child; D002675:Child, Preschool; D016724:Empyema, Pleural / Q000209:etiology / Q000628:therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D008297:Male; D011014:Pneumonia / Q000150:complications; D012189:Retrospective Studies; D013907:Thoracostomy; D013908:Thoracotomy
D005343:Fibrinolytic Agents