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Clinical Pediatrics
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Reviews

Parapneumonic Effusion and Empyema in Children: Retrospective Review of the duPont Experience

Raj Padman, MD

Division of Pulmonary, Alfred I. duPont Hospital for Children, Nemours Children's Clinic, Wilmington, DE, rpadman{at}nemours.org

Katherine A. King, MD

Division of Pulmonary, Alfred I. duPont Hospital for Children, Nemours Children's Clinic, Wilmington, DE

Sahir Iqbal

Division of Pulmonary, Alfred I. duPont Hospital for Children, Nemours Children's Clinic, Wilmington, DE

Philip J. Wolfson, MD

Department of Surgery, Alfred I. duPont Hospital for Children, Nemours Children's Clinic, Wilmington, DE

Management of pediatric parapneumonic effusions and empyema remains controversial. Treatment includes antibiotics, chest tube, fibrinolytic therapy, video-assisted thoracoscopy and debridement, and open thoracotomy and decortication. A retrospective 10-year study was done to identify patient selection variables for specific therapies. Charts (n = 101) with diagnoses of empyema without comorbidity were reviewed, a database was developed, and variables between patients who did and did not receive thoracoscopic debridement were compared at admission and during hospitalization. The difference in positive culture reports with video-assisted thoracoscopy compared with medical management was significant (P < .018). Postsurgical patients used the intensive care unit and had 2 or more chest tubes with greater frequency than medically managed patients (P < .014, P < .002). Antibiotics, video-assisted thoracoscopy, and chest tube within 48 hours of admission shortened hospitalization by 4 days (P < .001) compared with delayed video-assisted thoracoscopy done after 48 hours of admission.

Key Words: pediatric patients • parapneumonic effusion • empyema • experience

Clinical Pediatrics, Vol. 46, No. 6, 518-522 (2007)
DOI: 10.1177/0009922806299096
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