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Empyema associated with community-acquired pneumonia: a Pediatric Investigator's Collaborative Network on Infections in Canada (PICNIC) study.

Langley JM, Kellner JD, Solomon N, Robinson JL, Le Saux N, McDonald J, Ulloa-Gutierrez R, Tan B, Allen U, Dobson S, Joudrey H - BMC Infect. Dis. (2008)

Bottom Line: While similarity in use of pain medication, antipyretics and antimicrobial use was observed, a wide variation in number of chest radiographs and invasive procedures (thoracentesis, placement of chest tubes) was observed between centers.Variation in management by center was observed.Enhanced surveillance using molecular methods could improve diagnosis and public health planning, particularly with regard to the relationship between immunization programs and the epidemiology of empyema associated with community-acquired pneumonia in children.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pediatrics, Dalhousie University, Halifax, Canada. jmlangle@dal.ca

ABSTRACT

Background: Although the incidence of serious morbidity with childhood pneumonia has decreased over time, empyema as a complication of community-acquired pneumonia continues to be an important clinical problem. We reviewed the epidemiology and clinical management of empyema at 8 pediatric hospitals in a period before the widespread implementation of universal infant heptavalent pneumococcal vaccine programs in Canada.

Methods: Health records for children<18 years admitted from 1/1/00-31/12/03 were searched for ICD-9 code 510 or ICD-10 code J869 (Empyema). Empyema was defined as at least one of: thoracentesis with microbial growth from pleural fluid, or no pleural fluid growth but compatible chemistry or cell count, or radiologist diagnosis, or diagnosis at surgery. Patients with empyemas secondary to chest trauma, thoracic surgery or esophageal rupture were excluded. Data was retrieved using a standard form with a data dictionary.

Results: 251 children met inclusion criteria; 51.4% were male. Most children were previously healthy and those

Conclusion: Empyema occurs most commonly in children under five years and is associated with considerable morbidity. Variation in management by center was observed. Enhanced surveillance using molecular methods could improve diagnosis and public health planning, particularly with regard to the relationship between immunization programs and the epidemiology of empyema associated with community-acquired pneumonia in children.

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Incidence of admission with empyema associated with community-acquired pneumonia in Canadian children at 8 pediatric hospitals by month, 2001–2003.
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Figure 1: Incidence of admission with empyema associated with community-acquired pneumonia in Canadian children at 8 pediatric hospitals by month, 2001–2003.

Mentions: There were 251 cases in 251 children in 8 pediatric health centers who met inclusion criteria; 51.4% were male. The average age was 6.0 years (SD +/- 4.98). Caucasians comprised 42%; aboriginals 18%, Asians 7%, African-Canadian < 1% and other 12% (no data 20%). Most children were previously healthy (78%; 195/251). One or more underlying conditions were present in 19% (51/251) of children including asthma (n = 45), congenital heart disease (n = 8), immunocompromised state (n = 5), and cystic fibrosis (n = 2). In immunocompetent children the mean age was 6.0 years (SD 5.01) and the age distribution was ≤ 1 year = 8%, 12–23 months 11%, 24–35 months 14%%, 3 to 5 years = 24%, 6–10 years = 19%, ≥ 11 years = 24%. Admissions occurred in all months of the year but peaked between November and April (Figure 1).


Empyema associated with community-acquired pneumonia: a Pediatric Investigator's Collaborative Network on Infections in Canada (PICNIC) study.

Langley JM, Kellner JD, Solomon N, Robinson JL, Le Saux N, McDonald J, Ulloa-Gutierrez R, Tan B, Allen U, Dobson S, Joudrey H - BMC Infect. Dis. (2008)

Incidence of admission with empyema associated with community-acquired pneumonia in Canadian children at 8 pediatric hospitals by month, 2001–2003.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2571094&req=5

Figure 1: Incidence of admission with empyema associated with community-acquired pneumonia in Canadian children at 8 pediatric hospitals by month, 2001–2003.
Mentions: There were 251 cases in 251 children in 8 pediatric health centers who met inclusion criteria; 51.4% were male. The average age was 6.0 years (SD +/- 4.98). Caucasians comprised 42%; aboriginals 18%, Asians 7%, African-Canadian < 1% and other 12% (no data 20%). Most children were previously healthy (78%; 195/251). One or more underlying conditions were present in 19% (51/251) of children including asthma (n = 45), congenital heart disease (n = 8), immunocompromised state (n = 5), and cystic fibrosis (n = 2). In immunocompetent children the mean age was 6.0 years (SD 5.01) and the age distribution was ≤ 1 year = 8%, 12–23 months 11%, 24–35 months 14%%, 3 to 5 years = 24%, 6–10 years = 19%, ≥ 11 years = 24%. Admissions occurred in all months of the year but peaked between November and April (Figure 1).

Bottom Line: While similarity in use of pain medication, antipyretics and antimicrobial use was observed, a wide variation in number of chest radiographs and invasive procedures (thoracentesis, placement of chest tubes) was observed between centers.Variation in management by center was observed.Enhanced surveillance using molecular methods could improve diagnosis and public health planning, particularly with regard to the relationship between immunization programs and the epidemiology of empyema associated with community-acquired pneumonia in children.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pediatrics, Dalhousie University, Halifax, Canada. jmlangle@dal.ca

ABSTRACT

Background: Although the incidence of serious morbidity with childhood pneumonia has decreased over time, empyema as a complication of community-acquired pneumonia continues to be an important clinical problem. We reviewed the epidemiology and clinical management of empyema at 8 pediatric hospitals in a period before the widespread implementation of universal infant heptavalent pneumococcal vaccine programs in Canada.

Methods: Health records for children<18 years admitted from 1/1/00-31/12/03 were searched for ICD-9 code 510 or ICD-10 code J869 (Empyema). Empyema was defined as at least one of: thoracentesis with microbial growth from pleural fluid, or no pleural fluid growth but compatible chemistry or cell count, or radiologist diagnosis, or diagnosis at surgery. Patients with empyemas secondary to chest trauma, thoracic surgery or esophageal rupture were excluded. Data was retrieved using a standard form with a data dictionary.

Results: 251 children met inclusion criteria; 51.4% were male. Most children were previously healthy and those

Conclusion: Empyema occurs most commonly in children under five years and is associated with considerable morbidity. Variation in management by center was observed. Enhanced surveillance using molecular methods could improve diagnosis and public health planning, particularly with regard to the relationship between immunization programs and the epidemiology of empyema associated with community-acquired pneumonia in children.

Show MeSH
Related in: MedlinePlus