Original articleThoracoscopy in pediatric pleural empyema: a prospective study of prognostic factors
Section snippets
Patients
From September 1996 to December 2004, 50 children with pleural empyema were admitted to our department. The diagnosis was confirmed in all cases by bacteriological or biochemical study of liquid sample [11] (lactate dehydrogenase >1000 IU/L, glucose <40 mg/dL) and surgical findings (fibrin organization, purulent pleural fluid). Seven patients were enrolled retrospectively in this study, and 43, prospectively.
We recorded the following data: age, sex, and clinical findings; chronology of initial
Results
A marked increase in the incidence of empyema has been observed in our institution since 1996 (Fig. 1).
Discussion
An increase in the incidence of empyema has been reported since 1995, but the etiology is still largely unknown [13]. Although various therapeutic choices for pediatric empyema have been reported to be successful (chest tube drainage [14], thoracotomy [15], thoracoscopy [16], fibrinolytics [4], [5]), the aim of this work was to highlight the earliness of surgical treatment as the most favorable prognostic factor. To ensure the homogeneity of the study group, all patients underwent
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Thoracoscopy in the management of pediatric empyemas
2016, Revista Portuguesa de PneumologiaCitation Excerpt :The parallel increase in the reintervention rate along with decrease in conversion rate may indicate that a subset of patients ultimately needs a thoracotomy; however, our sample was too small to confirm this statement. Early surgical intervention has already been associated with better outcomes such as simpler procedures, shorter hospitalization, shorter intravenous antibiotic therapy, less postoperative complications and more important lower failure of the thoracoscopic approach in both adult and pediatric patients.4,7,12,14–18 In our series, preoperative fever duration was not related either to reintervention or conversion rates.
The diagnosis and management of empyema in children: A comprehensive review from the APSA outcomes and clinical trials committee
2012, Journal of Pediatric SurgeryCitation Excerpt :A retrospective series in children with empyema documented that VATS performed within 48 hours of diagnosis reduced hospital stay by 4 days on average [14]. Another retrospective study showed a delay between diagnosis and surgery of more than 4 days was significantly correlated with more frequent surgical difficulties, longer operative time, more postoperative fever, longer drainage time, longer hospitalization, and more postoperative complications [66]. Similarly, a retrospective comparison in adults found that patients with empyema have a more efficient course if treated with primary VATS compared tube thoracostomy alone with VATS reserved for failure [67].
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