title: Outcomes associated with type of intervention and timing in complex pediatric empyema.
abstract: BACKGROUND
  The presence of effusion/empyema in pediatric pneumonia can increase treatment complexity by possibly requiring pleural drainage. Currently, no data support the superiority of any drainage modalities in children.
  
  
  METHODS
  We performed a retrospective cohort study using the Pediatric Health Information System database from 2003 to 2008.
  
  
  RESULTS
  A total of 14,936 children were hospitalized with effusion/empyema. Fifty-two percent of children were treated with antibiotics alone. Compared with patients receiving a chest tube, patients receiving antibiotics alone, thoracotomy, and video-assisted thoracoscopic surgery had a shorter length of stay, lower mortality rates, and fewer re-interventions. Delaying drainage by 1 to 3 days was associated with a lower mortality rate, and a delay of more than 7 days was associated with a higher mortality rate.
  
  
  CONCLUSIONS
  Half of all children with effusion/empyema are treated with antibiotics alone with low morbidity and mortality. Initial video-assisted thoracoscopic surgery or thoracotomy had improved outcomes compared with other interventions. Intervention should not be delayed beyond 7 days.
authors.affiliation: Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Department of Surgery, University of Washington, 4800 Sand Point Way NE, M/S W-7729, PO Box 5371, Seattle, WA 98105, USA. Electronic address: adam.goldin@seattlechildrens.org.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Goldin
authors.affiliation: Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Department of Surgery, University of Washington, 4800 Sand Point Way NE, M/S W-7729, PO Box 5371, Seattle, WA 98105, USA.
authors.forename: Chinnaya
authors.initials: C
authors.lastname: Parimi
authors.affiliation: Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Department of Surgery, University of Washington, 4800 Sand Point Way NE, M/S W-7729, PO Box 5371, Seattle, WA 98105, USA.
authors.forename: Cabrini
authors.initials: C
authors.lastname: LaRiviere
authors.affiliation: Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Garrison
authors.affiliation: Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA.
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Larison
authors.affiliation: Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Department of Surgery, University of Washington, 4800 Sand Point Way NE, M/S W-7729, PO Box 5371, Seattle, WA 98105, USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Sawin
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016724:Empyema, Pleural / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome