Increase in incidence of childhood empyema in West Midlands, UK

Rees, J.S.; Spencer, DA; Parikh, Dakshesh; Weller, P

doi:10.1016/s0140-6736(97)80022-0

Cited by 108 publications

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“…In spite of the recent decreases in invasive pneumococcal disease, hospitalizations for empyema are increasing in US children (20). Recent reports further show that the incidence of empyema due to non-PCV-7 serotypes, especially types 1, 3, and 19A, has increased signifi cantly worldwide in the post PCV-7 era (11)(12)(13)(14)(15)(16)(17)21,32). These serotypes are historically associated with severe invasive disease, particularly empyema, and might contribute to the increased rates of deaths caused by empyema among adults (17,35,36).…”

Section: Discussionmentioning

confidence: 99%

Parapneumonic Empyema Deaths during Past Century, Utah

Bender¹,

Ampofo²,

Sheng³

et al. 2009

Emerg. Infect. Dis.

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Section: Discussionmentioning

confidence: 99%

Parapneumonic Empyema Deaths during Past Century, Utah

Bender¹,

Ampofo²,

Sheng³

et al. 2009

Emerg. Infect. Dis.

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“…(12) In adults, such forms have been linked with alcohol abuse, diabetes mellitus and nutritional deficiencies, (8) whereas, in children, this pathology is being described in previously healthy young children, even those without predisposing factors.…”

Section: Discussionmentioning

confidence: 99%

Pneumonia necrosante em crianças submetidas à toracoscopia por empiema pleural: incidência, tratamento e evolução clínica

Macedo¹,

Meyer²,

Oliveira³

2010

J. bras. pneumol.

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Objective: To assess the incidence of necrotizing pneumonia (NP) in children submitted to thoracoscopy, comparing patients with and without NP in terms of the presentation and clinical evolution. Methods: A retrospective study of children with pleural empyema submitted to thoracoscopy. Thoracoscopy was performed in patients not previously submitted to thoracic drainage and in whom there was evidence of loculated effusion or pneumothorax, as well as in those previously submitted to thoracic drainage and in whom there was persistent pneumothorax or fever with purulent discharge. On the basis of the thoracoscopy findings, patients were distributed into two groups: those with NP (NP group) and those without (no-NP group). Results: The study sample comprised 52 patients. Of the 24 patients with NP, 19 (79%) had undergone thoracic drainage prior to thoracoscopy, 11 (46%) presented with pneumothorax, and 16 (67%) developed bronchopleural fistula. In the NP group, the median drainage time and the median length of hospital stay were 18 and 19 days, respectively. Of the 28 patients without NP, 10 (36%) had undergone thoracic drainage prior to thoracoscopy, 9 (32%) presented pneumothorax, and 5 (18%) developed bronchopleural fistula. In the no-NP group, the median drainage time and the median length of hospital stay were 6 and 10 days, respectively. Conclusions: Pneumothorax should raise the suspicion of NP. Early thoracoscopy can be a valuable treatment option for NP in children because it hastens recovery in comparison with the medical treatment alone and avoids extensive late thoracotomy lung resections.Keywords: Empyema, pleural; Thoracoscopy; Pneumonia; Child. ResumoObjetivo: Analisar a incidência de pneumonia necrosante (PN) em crianças submetidas a toracoscopia e comparar pacientes com e sem PN em relação às diferentes apresentações e evolução clínica. Métodos: Estudo retrospectivo de crianças portadoras de empiema e submetidas a toracoscopia. A toracoscopia foi realizada em pacientes não submetidos a drenagem torácica prévia e evidência de derrame septado ou pneumotórax, assim como naqueles submetidos previamente a drenagem torácica e pneumotórax persistente ou febre e secreção purulenta. Baseado na presença de PN durante a toracoscopia, os pacientes foram divididos em dois grupos: com PN e sem PN. Resultados: Participaram do estudo 52 pacientes. Dos 24 pacientes com PN, 19 (79%) foram submetidos a drenagem torácica anterior à toracoscopia, 11 (46%) apresentaram pneumotórax, e 16 (67%) evoluíram com fístula broncopleural. Neste grupo, as medianas do tempo de drenagem e de hospitalização foram, respectivamente, 18 e 19 dias. Dos 28 pacientes sem PN, 10 (36%) foram submetidos a drenagem torácica anterior à toracoscopia, 9 (32%) apresentaram pneumotórax, e 5 (18%) evoluíram com fístula broncopleural. Neste grupo, as medianas do tempo médio de drenagem e de hospitalização foram, respectivamente, 6 e 10 dias. Conclusões: A PN deve ser suspeitada na presença de pneumotórax. A toracoscopia precoce pode ser uma opç...

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“…[1][2][3][4] The British Thoracic Society (BTS) guidelines on the management of empyema in children highlighted the lack of grade A evidence to inform best management. 5 Since its publication in 2005, this has been increasingly addressed by the publication of prospective randomised controlled studies.…”

mentioning

confidence: 99%

“…The American Thoracic Society (ATS) divided the empyema process into three stages: (1) exudative, in which the pleural fluid has a low cell content; (2) fibrinopurulent, in which frank pus is present and fibrin formation begins to cover the pleura with formation of loculations; and (3) organising phase, in which there is thick peel formation by fibroblasts and the pleural space is characterised by ''very thick exudates with heavy sediment''. 8 USS has been used to stage this process in children by demonstrating the presence of septations and to guide management; 9 however, the role of routine CT scanning in guiding management in children with empyema is not known.…”

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confidence: 99%

Role of routine computed tomography in paediatric pleural empyema

Jaffé

Calder

Owens

et al. 2008

Thorax

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Background: The incidence of empyema in children is increasing worldwide. While there are emerging data for the best treatment options, there is little evidence to support the imaging modalities used to guide treatment, particularly with regard to the role of routine CT scanning. The aims of this study were to develop a radiological scoring system for paediatric empyema and to assess the utility of routine CT scanning in this disease. Methods: Children with empyema were prospectively enrolled over a 3-year period into a randomised clinical trial of video-assisted thoracoscopic surgery versus percutaneous chest drain insertion and urokinase. All children received a preoperative chest radiograph (CXR), pleural ultrasound scan (USS) and chest CT scan. In the urokinase arm the clinician inserted the drain with USS evidence only and did not have access to the CT scan at the time of insertion to reflect clinical practice. A scoring system was developed for each individual radiological modality and used to compare imaging characteristics of the pleural fluid collection and underlying parenchyma and to assess the utility of USS and CT to predict length of stay after the intervention. Results: Of the 60 subjects recruited, 46 had USS images available for review, 36 had a CT scan which met the inclusion criteria and 31 had all three radiological measurements (CT, USS and CXR) available for analysis. There was substantial interobserver agreement for USS grades (k = 0.709) and moderate agreement for total CT scores (k = 0.520). There were weak correlations between USS grade and total CT score as well as CT loculation and density scores. Of the 25 CXRs showing simple opacification of the underlying parenchyma only, CT demonstrated simple consolidation (n = 14), necrotising pneumonia (n = 7), cavitary necrosis (n = 3) and pneumatoceles (n = 1). No abnormality was detected on CT scanning which directly altered clinical management. Neither the USS score nor the CT score, nor a combination of the two, were able to predict length of hospital stay. Conclusions: CT scanning detects more parenchymal abnormalities than chest radiography. However, the additional information does not alter management and is unable to predict clinical outcome. This suggests that there is no role for the routine use of CT scanning in children if treated with urokinase and percutaneous chest drain. The omission of routine CT scanning in empyema will reduce the exposure of children to unnecessary radiation and reduce costs. Trial registration number: The trial is fully registered with clinicaltrials.gov (ID: NCT00144950).Although relatively uncommon, the incidence of empyema in children is increasing in many countries.

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Increase in incidence of childhood empyema in West Midlands, UK

Cited by 108 publications

References 0 publications

Parapneumonic Empyema Deaths during Past Century, Utah

Parapneumonic Empyema Deaths during Past Century, Utah

Pneumonia necrosante em crianças submetidas à toracoscopia por empiema pleural: incidência, tratamento e evolução clínica

Role of routine computed tomography in paediatric pleural empyema

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