title: The diagnosis and management of empyema in children: a comprehensive review from the APSA Outcomes and Clinical Trials Committee.
abstract: The aim of this study is to review the current evidence on the diagnosis and management of empyema. The American Pediatric Surgical Association Outcomes and Clinical Trials Committee compiled 8 questions to address. A comprehensive review was performed on each topic. Topics included the distinction between parapneumonic effusion and empyema, the optimal imaging modality in evaluating pleural space disease, when and how pleural fluid should be managed, the first treatment option and optimal timing in the management of empyema, the optimal chemical debridement agent for empyema, therapeutic options if chemical debridement fails, therapy for parenchymal abscess or necrotizing pneumonia and duration of antibiotic therapy after an intervention. The evidence was graded for each topic to provide grade of recommendation where appropriate.
authors.affiliation: University of Florida College of Medicine, Gainesville, FL, USA.
authors.forename: Saleem
authors.initials: S
authors.lastname: Islam
authors.forename: Casey M
authors.initials: CM
authors.lastname: Calkins
authors.forename: Adam B
authors.initials: AB
authors.lastname: Goldin
authors.forename: Catherine
authors.initials: C
authors.lastname: Chen
authors.forename: Cynthia D
authors.initials: CD
authors.lastname: Downard
authors.forename: Eunice Y
authors.initials: EY
authors.lastname: Huang
authors.forename: Laura
authors.initials: L
authors.lastname: Cassidy
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Saito
authors.forename: Martin L
authors.initials: ML
authors.lastname: Blakely
authors.forename: Shawn J
authors.initials: SJ
authors.lastname: Rangel
authors.forename: Marjorie J
authors.initials: MJ
authors.lastname: Arca
authors.forename: Fizan
authors.initials: F
authors.lastname: Abdullah
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D003131:Combined Modality Therapy; D003646:Debridement; D003851:Deoxyribonucleases / Q000627:therapeutic use; D004322:Drainage; D016724:Empyema, Pleural / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D005100:Expectorants / Q000627:therapeutic use; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D035422:Pleural Cavity / Q000000981:diagnostic imaging / Q000601:surgery; D018410:Pneumonia, Bacterial / Q000150:complications; D020775:Thoracic Surgery, Video-Assisted; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D000900:Anti-Bacterial Agents; D005100:Expectorants; D005343:Fibrinolytic Agents; D003851:Deoxyribonucleases