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A review of the newly published guidelines on the management of pleural infection in children
Commissioned by the British Thoracic Society (BTS) Standards of Care Committee, the BTS guidelines for the management of pleural infection in children are published as a supplement to this month’s issue of Thorax.1 They have also been subject to scrutiny by the Quality of Practice Committee (QPC) of the Royal College of Paediatrics and Child Health (RCPCH) using the AGREE appraisal instrument, and consequently have been endorsed by the RCPCH. So why did we write them and was it worth it? More importantly—should you read them? What follows are my views as chair of the guideline committee and may not represent those of the other members of the committee (listed in the Acknowledgements).
WHY DID WE WRITE THEM?
We are not paediatricians for nothing—we understand sibling rivalry—so when the adult respiratory physicians got an empyema guideline,2 we wanted one. However, it was more than just that. There are major differences between adult and paediatric pleural infections. The principal one is that most children are fit and well before they contract pneumonia and develop an empyema, so the outcome is almost always excellent. This is in contrast to the disease in adults where empyema is a cause of significant morbidity and mortality (recent data has revealed a 12% mortality rate even in those without cancer3). Nevertheless, management of childhood empyema can still be a therapeutic challenge. Unfortunately, in the UK there is little consensus over best practice, both among respiratory paediatricians and also thoracic surgeons. It was therefore considered important to synthesise the available evidence and write guidelines, even though they may only point people in the right direction and highlight the unresolved issues. It is hoped that the guidelines will facilitate dissemination of evidence and standardisation …
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