 |
|
Rational Treatment of Empyema in Children
Andreas H. Meier, MD;
Baird Smith, MD;
Arun Raghavan, BS;
R. Lawrence Moss, MD;
Michael Harrison, MD;
Erik Skarsgard, MD
Arch Surg. 2000;135:907-912.
Hypothesis Efficacious and cost-effective treatment of pediatric empyema can be accomplished following a protocol based on its radiographic appearance. Therapeutic modalities include thoracostomy tube drainage (TTD) with or without fibrinolytic therapy (FT) and video-assisted thoracoscopic debridement (VATD).
Design Retrospective case series.
Setting Tertiary referral center.
Results From 1995 through 1999, 31 children were treated ranging in age from 11 months to 18 years (mean age, 5.1 years). Twenty-seven (87.1%) underwent TTD; of these, 22 (81.5%) received FT with urokinase. The TTD failed in 4 children (14.8%) who required salvage VATD. Primary VATD was performed in another 4 children (12.9%). The mean length of stay was 14.6 days (TTD, 14.1 days; salvage VATD, 20.0 days; primary VATD, 11.5 days), ranging from 8.0 to 30.0 days. Complications included readmission for fever (2 patients [6.5%]) and gastrointestinal bleeding (1 patient [3.2%]). There were no anaphylactic reactions or bleeding episodes due to urokinase. Two patients (7.4%) treated with TTD and FT developed an air leak that resolved spontaneously. The mean hospital charges were $78,832 (TTD with or without FT, $75,450; salvage VATD, $107,476; primary VATD, $69,634). The procedural charges were highest for salvage VATD.
Conclusions Most cases of pediatric empyema can be treated by TTD with or without FT. This therapy is safe and effective for children with nascent disease. Primary VATD is preferred in children with advanced disease. Cost-effectiveness could be further improved through better prediction of those patients likely to fail TTD and require salvage VATD. An algorithmic approach based on findings from computed tomography or (better) ultrasonography of the chest may be the best way to make this distinction and rationalize care.
From the Division of Pediatric Surgery, Stanford University, Stanford, Calif.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Primary Operative Management for Pediatric Empyema: Decreases in Hospital Length of Stay and Charges in a National Sample
Li and Gates
Arch Pediatr Adolesc Med 2008;162:44-48.
ABSTRACT
| FULL TEXT
Comparison of Urokinase and Video-assisted Thoracoscopic Surgery for Treatment of Childhood Empyema
Sonnappa et al.
Am. J. Respir. Crit. Care Med. 2006;174:221-227.
ABSTRACT
| FULL TEXT
Outcome of Pediatric Empyema Thoracis Managed by Tube Thoracostomy
Rodriguez and Catalan
Asian Cardiovasc. Thorac. Ann. 2006;14:98-101.
ABSTRACT
| FULL TEXT
Primary Operative Versus Nonoperative Therapy for Pediatric Empyema: A Meta-analysis
Avansino et al.
Pediatrics 2005;115:1652-1659.
ABSTRACT
| FULL TEXT
BTS guidelines for the management of pleural infection in children
Balfour-Lynn et al.
Thorax 2005;60:i1-i21.
FULL TEXT
The Changing Face of Pleural Empyemas in Children: Epidemiology and Management
Schultz et al.
Pediatrics 2004;113:1735-1740.
ABSTRACT
| FULL TEXT
Effectiveness and Safety of Tissue Plasminogen Activator in the Management of Complicated Parapneumonic Effusions
Weinstein et al.
Pediatrics 2004;113:e182-185.
ABSTRACT
| FULL TEXT
Tissue Plasminogen Activator as an Adjuvant Therapy for Pleural Empyema in Pediatric Patients
Ray et al.
J Intensive Care Med 2004;19:44-50.
ABSTRACT
Thoracic empyema
Jaffe and Cohen
Arch. Dis. Child. 2003;88:839-841.
FULL TEXT
Management of parapneumonic effusion and empyema
Hilliard et al.
Arch. Dis. Child. 2003;88:915-917.
ABSTRACT
| FULL TEXT
Alteplase in the Treatment of Complicated Parapneumonic Effusion: A Case Report
Bishop et al.
Pediatrics 2003;111:e188-190.
ABSTRACT
| FULL TEXT
Atoms
Marcovitch
Arch. Dis. Child. 2002;87:267-267.
FULL TEXT
Radiological perspectives in empyema: Childhood respiratory infections
King and Thomson
Br Med Bull 2002;61:203-214.
ABSTRACT
| FULL TEXT
|
