Therapy of 645 children with parapneumonic effusion and empyema—A German nationwide surveillance study

Abstract

SummaryObjective: To evaluate the initial management of pediatric parapneumonic effusion or pleural empyema (PPE/PE) with regard to length of hospital stay (LOS). Methods: 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. Results: 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. Conclusions: 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.

Real-time ultrasound-guided pigtail catheter chest drain for complicated parapneumonic effusion and empyema in children – 16-year, single-centre experience of radiologically placed drains

“…In a national surveillance study in Germany examining the treatment of 645 children with parapneumonic effusion/empyema over nearly three years, less than a quarter required invasive intervention with only 89 receiving a chest drain with intrapleural fibrinolysis and 43 a surgical procedure (either video-assisted thoracoscopic surgery or an open thoracotomy). There were no significant differences in the length of stay between surgical and drain patients [16]. …”

Pediatric Pulmonology year in review 2017: Part 3

“…Interestingly, there were no differences in length of stay, total days of antibiotics, or duration of fever between patients treated conservatively, compared to those treated with chest tubes with or without fibrinolysis. Similarly, in a 3‐year prospective, observational study in Germany, Segerer et al found no difference in length of hospital stay among children with effusion or empyema whether they were initially treated invasively (thoracentesis, chest tubes, or video‐assisted thoracoscopic surgery) or non‐invasively (antibiotics only).…”

“…59 As referenced above, a nationwide prospective, observational study in Germany found no difference in length of hospital stay among children with effusion or empyema whether they were initially treated invasively (thoracentesis, chest tubes, surgical drainage procedures) or not. 50 Chang et al 60 Mycobacterium tuberculosis is the leading cause of death worldwide from a single bacterial pathogen. 63 The World Health…”

“…A randomized, double blind placebo controlled multicenter trial carried out in Spain found that dexamethasone (0.25 mg/kg/dose every 6 h, for 48 h) shortened the duration of illness due to parapneumonic effusion, when coupled with antibiotics . As referenced above, a nationwide prospective, observational study in Germany found no difference in length of hospital stay among children with effusion or empyema whether they were initially treated invasively (thoracentesis, chest tubes, surgical drainage procedures) or not …”

Question 1 What is the best treatment option for empyema requiring drainage in children?

“…All abstracts were reviewed; four prospective randomised studies were identified. We did not consider studies that compared VATS with chest drain without fibrinolytics1 or national surveillance studies 2. All references in these papers were reviewed, and no further relevant papers were found.…”