DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20213306

Empyema thoracis in children: analysis from a tertiary care center

Parth K. Thakkar, Niranjan Shendurnikar, Hitesh Desai, Vikas Doshi

Abstract


Background: Empyema thoracis refers to infection and pus formation within the pleural space in the thorax. It is estimated that 0.6% of childhood pneumonia’s progress to empyema, affecting 3.3 per 100000 children. The purpose of this study was to analyse the clinical and bacteriological profile, outcome of empyema in children with reference to intercostal drainage/tube thoracostomy (ICD/TT) and video assisted thoracoscopic surgery (VATS).

Methods: A hospital based prospective comparative study was conducted on 61 children diagnosed with empyema thoracis according to ICD-10 code J869 between 6 months to 18 years of age admitted to K. G. P. children hospital, Vadodara over a period of 20 months from September 2018 to May 2020.

Results: Most of patients (63.9%) were seen in age group of 1-5 years. Fever (100%), cough (99%) and breathlessness (85%) were the commonest presenting features. Pleural fluid culture was positive in (28%) of patients and Staphylococcus aureus (11.5%) was the most frequent organism isolated from pleural fluid. The mean duration of ICU stays, the mean duration of hospital stays and time taken for removal of ICD was less VATS group with statistically significant difference.

Conclusions: Empyema in children causes significant morbidity which can be reduced by appropriate treatment of bacterial pneumonia. ICD and antibiotics are effective method to facilitate drainage and resolution of empyema in resource poor settings. VATS is effective treatment for empyema when presented with stage 2 and stage 3 empyema having multiple loculation, which decreases duration of hospital treatment.


Keywords


Empyema thoracis, Tube thoracostomy, Video assisted thoracoscopic surgery

Full Text:

PDF

References


Singh M, Singh SK, Chowdhary SK. Management of empyema thoracic in children. Indian Pediatr. 2002;39(2):145-57.

Deluca A, Kurland G. Empyema in children: epidemiology, diagnosis and management. Sem Pediatr Infect Dis. 1998;9:205-11.

Sethi GR, Singhal K. Parapneumonic effusion and empyema. In: Gupta P, Menon PS, Ramji S, Lodha R, eds. PG Textbook of Pediatrics. 2nd ed. New Delhi: Jaypee Brothers Medical Publisher; 2018: 2041-4.

Balfour-Lynn IM, Abrahamson E, Cohen G, Hartley J, King S, Parikh D, et al. BTS guidelines for the management of pleural infection in children. Thorax. 2005;60(1):1-21.

Schultz KD, Fan LL, Pinsky J, Ochoa L, Smith EB, Brandt ML. The changing face of pleural empyema in children: epidemiology and management. Pediatrics. 2004;113(6):1735-40.

Langley JM, Kellner JD, Solomon N, Robinson JL, LeSaux N, McDonald J, et al. Empyema associated with community-acquired pneumonia: a pediatric investigator's collaborative network on infections in Canada (PICNIC) study. BMC Infect Dis. 2008;8:129.

Parelkar SV, Patil SH, Sanghvi BV, Gupta RK, Mhaskar SS, Shah RS, et al. Video-assisted thoracoscopic surgery for pediatric empyema by two-port technique: a single-center experience with 167 consecutive cases. J Indian Assoc Pediatr Surg. 2017;22(3):150-4.

Goyal V, Kumar A, Gupta M, Sandhu HP, Dhir S. Empyema thoracis in children: Still a challenge in developing countries. Afr J Paediatr Surg. 2014;11(3):206-10.

Rao MS, Chandra PS. A study of pediatric empyema thoracis presentation in a tertiary care hospital in Visakhapatnam, India. Int J Contem Pediatr. 2018;5(2):572.

Sharma S, Sonker SK, Nirala S. Prospective comparative study of video assisted thoracoscopic surgery versus conventional thoracostomy drainage in emyema thoracis in pediatric age group. Int J Res Med Sci. 2015;3(10):2538-42.

Gün F, Salman T, Abbasoglu L, Salman N, Çelik A. Early decortication in childhood empyema thoracis. Acta Chir Belg. 2007;107(2):225-7.

Demirhan R, Kosar A, Sancakli I, Kiral H, Orki A, Arman B. Management of postpneumonic empyemas in children. Acta Chirurgica Belgica. 2008;108(2):208-11.

Mangete ED, Kombo BB, Legg-Jack TE. Thoracic empyema: a study of 56 patients. Arch Dis Child. 1993;69(5):587-8.

Barnes NP, Hull J, Thomson AH. Medical management of parapneumonic pleural disease. Pediatr Pulmonol. 2005;39(2):127-34.

Cohen G, Hjortdal V, Ricci M, Jaffe A, Wallis C, Dinwiddie R, et al. Primary thoracoscopic treatment of empyema in children. J Thorac Cardiovasc Surg. 2003;125(1):79-83.

Peter SD, Tsao K, Harrison C, Jackson MA, Spilde TL, Keckler SJ, et al. Thoracoscopic decortication vs tube thoracostomy with fibrinolysis for empyema in children: a prospective, randomized trial. J Pediatr Surg. 2009;44(1):106-11.