title: Seventeen-year study shows rise in parapneumonic effusion and empyema with higher treatment failure after chest tube drainage.
abstract: OBJECTIVE
  To evaluate epidemiology, pre-admission characteristics and management of paediatric parapneumonic effusions (PPEs) and empyema in a tertiary paediatric pulmonary centre between 1993 and 2010.
  
  
  METHODS
  Retrospective chart review study using paediatric and thoracic database searches, with particular emphasis on pre-admission characteristics, disease stage (simple or complex effusion or empyema), general management and surgical procedures.
  
  
  RESULTS
  One hundred children were eligible, exhibiting a significant increase in incidence from 0.5 to 2.6 per 100 000 across the study period. Baseline characteristics were similar across disease stages. Streptococcus pneumoniae was the most common pathogen. Surgical intervention beyond chest tube drainage (CTD) was required in 50%; this rate showed a particular increase in children aged 0-5 years (OR, 3.1), but was otherwise not influenced by baseline characteristics, disease stage or use of intrapleural fibrinolytics. Length of hospitalisation did not differ across disease stages or primary interventional procedures.
  
  
  CONCLUSIONS
  This study confirmed an increasing incidence of PPEs and empyema in a Scandinavian tertiary paediatric pulmonary centre. Young children exhibited higher treatment failure after CTD. Length of hospitalisation was similar across disease stages and was comparable to previous reports according to primary interventional procedure.
authors.affiliation: Paediatric Pulmonary Service, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Danny
authors.initials: D
authors.lastname: Yu
authors.forename: Frederik
authors.initials: F
authors.lastname: Buchvald
authors.forename: Bodil
authors.initials: B
authors.lastname: Brandt
authors.forename: Kim G
authors.initials: KG
authors.lastname: Nielsen
mesh_terms: D015505:Chest Tubes / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003718:Denmark / Q000453:epidemiology; D016724:Empyema, Pleural / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy*; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D010996:Pleural Effusion / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy*; D018410:Pneumonia, Bacterial / Q000150:complications* / Q000382:microbiology; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D013907:Thoracostomy; D017211:Treatment Failure
keywords: Chest tube drainage; Childhood pneumonia; Empyema thoracis; Parapneumonic effusion; Scandinavia