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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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Clinical presentation of children with empyema associated with community-acquired pneumonia: percentage of children with each symptom and sign on admission.
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Figure 2: Clinical presentation of children with empyema associated with community-acquired pneumonia: percentage of children with each symptom and sign on admission.

Mentions: At presentation the most common symptoms were fever, cough and breathing difficulty (tachypnea), and the most common signs were abnormal air entry on auscultation, dullness to percussion, tachypnea, and fever (Figure 2). The diagnosis of empyema was made within 24 hours of admission in 63% of children and by the fifth hospital day in 95%. The most commonly performed diagnostic procedure was chest radiography (96.8% of children). About 16% of children had at least seven chest radiographs during their stay while 10% of children had two or fewer chest radiographs. Computerized tomography of the chest was performed in 64% of children (range 25–86% of children by center). Chest ultrasound was performed on 51% of children (range 28–90% of children by center).


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)

Clinical presentation of children with empyema associated with community-acquired pneumonia: percentage of children with each symptom and sign on admission.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Clinical presentation of children with empyema associated with community-acquired pneumonia: percentage of children with each symptom and sign on admission.
Mentions: At presentation the most common symptoms were fever, cough and breathing difficulty (tachypnea), and the most common signs were abnormal air entry on auscultation, dullness to percussion, tachypnea, and fever (Figure 2). The diagnosis of empyema was made within 24 hours of admission in 63% of children and by the fifth hospital day in 95%. The most commonly performed diagnostic procedure was chest radiography (96.8% of children). About 16% of children had at least seven chest radiographs during their stay while 10% of children had two or fewer chest radiographs. Computerized tomography of the chest was performed in 64% of children (range 25–86% of children by center). Chest ultrasound was performed on 51% of children (range 28–90% of children by center).

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