title: Trends in treatment of infectious parapneumonic effusions in U.S. children's hospitals, 2004-2014.
abstract: OBJECTIVE
  The purpose of this study was to examine trends in the treatment of patients with infectious parapneumonic effusions in U.S. children's hospitals over the past decade.
  
  
  METHODS
  The PHIS database was queried for patients younger than 18years old with pneumonia and pleural effusion in three yearlong periods over the past decade. Variables included age, gender, payer, race/ethnicity, hospital region, hospital type, markers of illness severity, and treatment group (antibiotics alone, chest tube thoracostomy±thrombolytics, video-assisted thoracoscopy (VATS), or thoracotomy).
  
  
  RESULTS
  5569 patients were included in the final analysis. The proportion of patients treated with antibiotics alone increased from 62% to 74% from 2004 to 2014 (p<0.001). Among patients requiring pleural space drainage, the frequency of VATS peaked in 2009 (50.8%), dropping to 36.4% in 2014 (p<0.001), while tube thoracostomy, usually with fibrinolytics, rose from 39.0% in 2009 to 53.2% in 2014 (p<0.001).
  
  
  CONCLUSIONS
  In a select cohort of free-standing, tertiary care U.S. children's hospitals, antibiotic administration alone remains the most common treatment approach to infectious parapneumonic effusions. VATS treatment for those patients requiring pleural space drainage is being gradually supplanted by thoracostomy tube placement with instillation of fibrinolytics.
authors.affiliation: Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, NY; Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Dorman
authors.affiliation: Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, NY; Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY.
authors.forename: Kaveh
authors.initials: K
authors.lastname: Vali
authors.affiliation: Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, NY; Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY. Electronic address: drothstein@kaleidahealth.org.
authors.forename: David H
authors.initials: DH
authors.lastname: Rothstein
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015505:Chest Tubes / Q000706:statistics & numerical data / Q000639:trends; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D004322:Drainage / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006776:Hospitals, Pediatric / Q000639:trends*; D006801:Humans; D007223:Infant; D008297:Male; D010996:Pleural Effusion / Q000209:etiology / Q000628:therapy*; D011014:Pneumonia / Q000150:complications*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D020775:Thoracic Surgery, Video-Assisted / Q000706:statistics & numerical data / Q000639:trends; D013907:Thoracostomy / Q000706:statistics & numerical data / Q000639:trends; D013908:Thoracotomy / Q000706:statistics & numerical data / Q000639:trends; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data / Q000639:trends; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents; D005343:Fibrinolytic Agents
keywords: Empyema; Fibrinolytics; Parapneumonic effusion; VATS