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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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Variation in use of invasive interventions for management of children with empyema at 8 Canadian pediatric hospitals.
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Figure 3: Variation in use of invasive interventions for management of children with empyema at 8 Canadian pediatric hospitals.

Mentions: Although subspecialty consultation to the infectious disease, pulmonology, or surgery services was almost uniformly sought across the country (99% of all patients), use of chest tubes, thoracentesis and thorascopic lysis varied from center to center (Figure 3). Three centers did not perform thorascopic lysis during the study period. Chest tube placement occurred in 75% of children overall. The overall median time to chest tube insertion after admission was 1.5 days; all sites had a median insertion time of three days or less. The mean length of stay did not differ between children with and without chest tube placement (15.5 days v. 13.3 days, p = 0.30). Hospital stay ranged from 2 to 160 days, with a mean length of stay of 15 days (SD 15) and a median length of 9 days. The mean length of stay in immunocompromised children was 29 days (SD 15.4). No correlation was observed between length of hospital stay and the time to chest tube insertion (Pearson correlation coefficient 0.08).


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)

Variation in use of invasive interventions for management of children with empyema at 8 Canadian pediatric hospitals.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Variation in use of invasive interventions for management of children with empyema at 8 Canadian pediatric hospitals.
Mentions: Although subspecialty consultation to the infectious disease, pulmonology, or surgery services was almost uniformly sought across the country (99% of all patients), use of chest tubes, thoracentesis and thorascopic lysis varied from center to center (Figure 3). Three centers did not perform thorascopic lysis during the study period. Chest tube placement occurred in 75% of children overall. The overall median time to chest tube insertion after admission was 1.5 days; all sites had a median insertion time of three days or less. The mean length of stay did not differ between children with and without chest tube placement (15.5 days v. 13.3 days, p = 0.30). Hospital stay ranged from 2 to 160 days, with a mean length of stay of 15 days (SD 15) and a median length of 9 days. The mean length of stay in immunocompromised children was 29 days (SD 15.4). No correlation was observed between length of hospital stay and the time to chest tube insertion (Pearson correlation coefficient 0.08).

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