title: Pediatric Pleural Empyema in the Province of Quebec: Analysis of a 10-Fold Increase Between 1990 and 2007.
abstract: BACKGROUND
  Although the frequency of pneumonia has decreased over time, an increase in pleural empyema has been observed in different settings worldwide. This study assessed the epidemiology of community-acquired pediatric pleural empyema in the province of Quebec through validation of cases found in a hospitalization discharge database.
  
  
  METHODS
  We used the national administrative database of hospitalization to identify children (6 months-14 years) hospitalized for pleural empyema or pleural effusion with drainage from January 1990 until December 2007 and reviewed their medical charts. Patients with pleural effusion secondary to chest trauma, thoracic surgery, malignancies, cardiac failure, or metabolic disorders were excluded.
  
  
  RESULTS
  Predictive positive value (PPV) of empyema code in any position among discharge diagnostics in the administrative database was 86.5% (95% confidence interval: 81.9%-90.3%). After chart revision, 292 met the inclusion criteria. Age-adjusted incidence of pleural empyema in the pediatric population increased from 0.23 in 1990 to 4.01/100,000 person-years in 2007. A bacterial pathogen was identified in 46.5%; Streptococcus pneumoniae (Sp) (42%) and S pyogenes (30%) were most frequent. There was no obvious change in the PPV and proportions of children with chronic disease or asthma and in identified pathogens over time, but an increase in pre-admission respiratory symptoms duration (from 3.8 days to 5.7) and nonsteroidal anti-inflammatory drug use (from 0% to 19%) was observed.
  
  
  CONCLUSIONS
  From 1990 to 2007, we observed a 10-fold increase in the incidence of pediatric hospitalizations associated with pleural empyema. This increase preceded the introduction of a pneumococcal conjugated vaccine program in Quebec. Sp remained the major pathogen identified.
authors.affiliation: Quebec University Hospital Research Centre, Quebec City (QC), Canada.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Deceuninck
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics and Medical Microbiology, The Montreal Children's Hospital and McGill University, and.
authors.forename: Caroline
authors.initials: C
authors.lastname: Quach
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, CHU-Sainte-Justine and University of Montreal, Montreal, Quebec, Canada.
authors.forename: Markos
authors.initials: M
authors.lastname: Panagopoulos
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, CHU Quebec and Laval University, Quebec City, Quebec, Canada.
authors.forename: Roseline
authors.initials: R
authors.lastname: Thibeault
authors.affiliation: Department of Pediatrics, CHU Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Thérèse
authors.initials: T
authors.lastname: Côté-Boileau
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, CHU-Sainte-Justine and University of Montreal, Montreal, Quebec, Canada.
authors.forename: Bruce
authors.initials: B
authors.lastname: Tapiéro
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, CHU-Sainte-Justine and University of Montreal, Montreal, Quebec, Canada.
authors.forename: Léna
authors.initials: L
authors.lastname: Coïc
authors.affiliation: Department of Social and Preventive Medicine, Laval University, Quebec City, Quebec, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: De Wals
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, CHU-Sainte-Justine and University of Montreal, Montreal, Quebec, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Ovetchkine
keywords: database validation; epidemiology; pediatric population; pleural empyema