title: Empyema thoracis in children: clinical presentation, management and complications.
abstract: OBJECTIVE
  To determine the etiology, clinical manifestation, management (medical and surgical) and complications of children with empyema thoracis in a tertiary care hospital from Karachi, Pakistan.
  
  
  METHODS
  Descriptive, analytical study.
  
  
  METHODS
  Department of Surgery, The Aga Khan University Hospital, Karachi, from January 1996 to December 2010.
  
  
  METHODS
  Medical records of admitted children aged > a month to 15 years with discharge diagnosis of empyema thoracis and data was collected on demographic features, clinical manifestation, management and complications. Children managed medically were compared with those managed surgically by using interquartile range and median comparison. Mann-Whitney U test was used to compare age in months, weight (kg) and length of stay in days and presenting complaint, duration of illness; chi-square test was used to compare thrombocytosis in between groups and p-value was calculated.
  
  
  RESULTS
  Among the 112 patients, 59 (53%) were younger than 5 years of age. Males (n=83, 74%) were predominant. Fifty (45%) children were admitted in winter. Thirty (27%) children found unvaccinated and one fourth (n=27; 24%) were severely malnourished. Fever, cough, and dyspnea were the major presenting symptoms. Sixty-six (59%) were on some antibiotics prior to admission. Staphylococcus aureus (n=13) and Streptococcus pneumoniae (n=5) were the commonest organism isolated from blood and pleural fluid cultures. Majority of the children required some surgical intervention (n=86). Surgically managed children were younger (p=0.01); had less weight (p=0.01) and prolonged fever (p=0.02); and stayed longer in hospital (p < 0.001) as compared to medically managed children. Requiring readmission (n=8), subcutaneous emphysema (n=5) and recollection of pus (n=5) were the major complications.
  
  
  CONCLUSIONS
  Staphylococcus aureus was the major organism associated with paediatric empyema thoracis. Early identification and empiric antibiotic as per local data is essential to prevent short and long-term complications. Younger, lower weight children with prolonged fever required surgical management.
authors.affiliation: Department of Pediatrics and Child Health, The Aga Khan University Hospital, Karachi.
authors.forename: Ali Faisal
authors.initials: AF
authors.lastname: Saleem
authors.affiliation: Department of Pediatrics and Child Health, The Aga Khan University Hospital, Karachi.
authors.forename: Abdul Sattar
authors.initials: AS
authors.lastname: Shaikh
authors.affiliation: Department of Pediatrics and Child Health, The Aga Khan University Hospital, Karachi.
authors.forename: Reema Sajjad
authors.initials: RS
authors.lastname: Khan
authors.affiliation: Department of Surgery, The Aga Khan University Hospital, Karachi.
authors.forename: Fazal
authors.initials: F
authors.lastname: Khan
authors.affiliation: Department of Surgery, The Aga Khan University Hospital, Karachi.
authors.forename: Ahmad Vaqas
authors.initials: AV
authors.lastname: Faruque
authors.affiliation: Department of Surgery, The Aga Khan University Hospital, Karachi.
authors.forename: Muhammad Arif Mateen
authors.initials: MA
authors.lastname: Khan
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D004322:Drainage; D016724:Empyema, Pleural / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery*; D005260:Female; D005334:Fever / Q000209:etiology; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D008297:Male; D044342:Malnutrition / Q000150:complications; D017063:Outcome Assessment, Health Care; D010154:Pakistan; D011013:Pneumonectomy; D015995:Prevalence; D017678:Sex Distribution
chemical_list: D000900:Anti-Bacterial Agents