title: Therapy of 645 children with parapneumonic effusion and empyema-A German nationwide surveillance study.
abstract: To evaluate the initial management of pediatric parapneumonic effusion or pleural empyema (PPE/PE) with regard to length of hospital stay (LOS).
  
  
  
  Collection of pediatric PPE/PE cases using a nationwide surveillance system (ESPED) from 10/2010 to 06/2013, in all German pediatric hospitals. Inclusion of PPE/PE patients <18 years of age requiring drainage or with a PPE/PE persistence >7 days. Staging of PPE/PE based on reported pleural sonographic imaging. Comparison of LOS after diagnosis between children treated with different forms of initial invasive procedures performed ≤3 days after PPE/PE diagnosis: pleural puncture, draining catheter, intrapleural fibrinolytic therapy, surgical procedures.
  
  
  
  Inclusion of 645 children (median age 5 years); median total LOS 17 days. Initial therapy was non-invasive in 282 (45%) cases and invasive in 347 (55%) cases (pleural puncture: 62 [10%], draining catheter: 153 [24%], intrapleural fibrinolytic therapy: 89 [14%], surgical procedures: 43 [7%]). LOS after diagnosis did not differ between children initially treated with different invasive procedures. Results remained unchanged when controlling for sonographic stage, preexisting diseases, and other potential confounders. Repeated use of invasive procedures was observed more often after initial non-invasive treatment or pleural puncture alone than after initial pleural drainage, intrapleural fibrinolytic therapy or surgery.
  
  
  
  Initial treatment with intrapleural fibrinolytic therapy or surgical procedures did not result in shorter LOS than initial pleural puncture alone. Larger prospective studies are required to investigate which children benefit significantly from more intensive forms of initial invasive treatment. Pediatr Pulmonol. 2017;52:540-547. © 2016 The Authors. Pediatric Pulmonology Published by Wiley Periodicals, Inc.
authors.affiliation: Department of Pediatrics, University of Würzburg, Würzburg, Germany.
authors.forename: Florian J
authors.initials: FJ
authors.lastname: Segerer
authors.affiliation: Department of Pediatrics, University of Würzburg, Würzburg, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Seeger
authors.affiliation: Department of Pediatrics, University of Würzburg, Würzburg, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Maier
authors.affiliation: Department of Pediatrics, University of Würzburg, Würzburg, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Hagemann
authors.affiliation: Institute of Hygiene and Microbiology, University of Würzburg, Würzburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schoen
authors.affiliation: Department of Medical Microbiology, National Reference Center for Streptococci, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Mark
authors.initials: M
authors.lastname: van der Linden
authors.affiliation: Department of Pediatrics, University of Würzburg, Würzburg, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Streng
authors.affiliation: Children's Hospital, Goethe University of Frankfurt, Frankfurt, Germany.
authors.forename: Markus A
authors.initials: MA
authors.lastname: Rose
authors.affiliation: Department of Pediatrics, University of Würzburg, Würzburg, Germany.
authors.forename: Johannes G
authors.initials: JG
authors.lastname: Liese
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D015505:Chest Tubes; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D016724:Empyema, Pleural / Q000188:drug therapy / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D005858:Germany / Q000453:epidemiology; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D007902:Length of Stay; D008297:Male; D010996:Pleural Effusion / Q000188:drug therapy / Q000453:epidemiology* / Q000628:therapy; D011014:Pneumonia / Q000188:drug therapy / Q000453:epidemiology* / Q000628:therapy; D011159:Population Surveillance; D011446:Prospective Studies; D012720:Severity of Illness Index
chemical_list: D000900:Anti-Bacterial Agents
keywords: VATS; intrapleural fibrinolytic therapy; pediatric parapneumonic pleural effusion; pleural empyema