Management Strategies and Outcomes of Pediatric Empyema Thoracis: A Retrospective Observational Study

Abstract

Background: Bacterial pneumonia leading to pleural empyema is the primary reason for pleural effusion in children. If antibiotic treatment is unsuccessful, the preferred treatment options are intercostal chest tube drainage and thoracotomy decortication. Objectives: The present study aimed to compare outcomes of different treatment methods: Antibiotics only, chest tubes without fibrinolytic, chest tubes with fibrinolytic administration, and surgery (VATS or open thoracotomy). Methods: This was a retrospective observational study conducted in a tertiary referral center in Tehran, Iran. Ninety-seven children (aged 1 month to 18 years) with parapneumonic pleural effusion (PPE) and empyema admitted to the Mofid Pediatric Hospital from March 2016 to February 2022 were included in this study. Patients were divided into four groups based on the initial treatment within the first week of admission. Remission rate after initial treatment, mortality rate, complications, readmission within two weeks of discharge, length of hospital stay (LOS), and length of fever (LOF) after admission were compared between these four groups. Additionally, the outcomes were compared between patients with and without comorbidities. Results: Among the 97 included patients, 50 were male and 47 were female. The median age was 5.48 ± 3.79 years. Fever, cough, and gastrointestinal (GI) symptoms were the most common symptoms. The pleural fluid culture was negative among 78.4% of the participants. The initial treatment included antibiotics alone (group 1) in 14 patients (14.4%); chest tube placement (group 2) in 38 patients (39.2%); chest tube with fibrinolytic administration (group 3) in 28 patients (28.9%); and thoracotomy in 9 patients (9.3%) or video-assisted thoracoscopic surgery (VATS) (group 4) in 8 patients (8.2%). Remission after initial treatment was significantly different between groups (P = 0.011). The surgery group had the highest remission rate (94.1%). Differences in LOS, LOF, mortality, complications, and readmission rate by initial treatment method were not significant. Comorbidity prevalence among groups was not significantly different, and the outcome of patients with comorbidity was similar to those without comorbidity. Conclusions: Surgical interventions have been associated with a greater remission rate. This study’s findings have clinical implications by aiding in designing standard protocols for the proper management of empyema.