title: Management of children with empyema: Pleural drainage is not always necessary.
abstract: BACKGROUND
  There is considerable variation in the management of pediatric empyema, and there are no clear criteria for when to perform pleural drainage. Our study aims were: (1) to retrospectively review our experience with an empyema treatment strategy that started with intravenously administered (IV) antibiotics alone in medically stable patients with procession to pleural drainage only if there was no clinical improvement after 48 hr, and (2) to identify predictors for undergoing pleural drainage.
  
  
  METHODS
  We performed a retrospective review of 182 previously healthy children, 1-18 years old, hospitalized with empyema from December 1996 through December 2008. The primary outcome measures were the proportion of patients requiring pleural drainage procedures and hospital length of stay (LOS).
  
  
  RESULTS
  Ninety-five children (52%) received antibiotics alone, and 87 (45%) underwent drainage procedures (21 chest tube alone, 57 VATS/thoracotomy, and 8 chest tube followed by VATS/thoracotomy); only 4 received fibrinolytics. Mean (standard deviation) LOS was significantly shorter in the antibiotics alone group, 7.0 (3.5) versus 11 (4.0) days. The strongest predictors of undergoing pleural drainage were admission to the intensive care unit and large effusion size (>(1/2) thorax filled).
  
  
  CONCLUSIONS
  Some children with empyema can be treated with IV antibiotics alone and have reasonably short LOS. At our institution, those that required intensive care or had large effusions with mediastinal shift were more likely to require pleural drainage.
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, Washington, USA. edward.carter@seattlechildrens.org
authors.forename: Edward
authors.initials: E
authors.lastname: Carter
authors.forename: John
authors.initials: J
authors.lastname: Waldhausen
authors.forename: Weiya
authors.initials: W
authors.lastname: Zhang
authors.forename: Lucas
authors.initials: L
authors.lastname: Hoffman
authors.forename: Gregory
authors.initials: G
authors.lastname: Redding
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015505:Chest Tubes; D002648:Child; D002675:Child, Preschool; D004322:Drainage; D016724:Empyema, Pleural / Q000188:drug therapy / Q000382:microbiology / Q000628:therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D010996:Pleural Effusion / Q000188:drug therapy / Q000382:microbiology / Q000628:therapy*; D018410:Pneumonia, Bacterial / Q000150:complications* / Q000382:microbiology; D012189:Retrospective Studies; D013907:Thoracostomy; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D005343:Fibrinolytic Agents