Griffith D, et al. – This paper aimed at describing the evolution in management of children with parapneumonic effusion and empyema in a tertiary referral centre. Researchers realized that intercostal drainage and intrapleural fibrinolytics could successfully manage parapneumonic effusion, but a proportion required further surgical intervention. In their hospital, there appeared an increase in the utilisation of fibrinolysis and video assisted thoracoscopic surgeries (VATS) with a corresponding decrease in the need for thoracotomy. Patients needing thoracotomy all had severe disease on ultrasound, but ultrasound did not reliably predict failure of fibrinolytic therapy.

Methods

• From December 2006 to December 2015, a retrospective case note review was performed of paediatric patients with parapneumonic effusion, pleural effusion and pleural empyema.
• Authors performed digital database searches to identify demographic data, referring hospital, radiological and microbiological investigations.
• Analysis of length of stay and morbidity was performed.

Results

• Over the study period, one hundred fifteen patients underwent 159 interventions.
• 54 children were successfully managed with intercostal drainage (ICD) and urokinase fibrinolysis alone.
• 19 primary video assisted thoracoscopic surgeries (VATS) and 12 VATS after initial intercostal drains were observed.
• 33 children underwent a thoracotomy, a reduction of 26% from the previous era (p = 0.009).
• Mean length of stay period was of 9 days (range 2–54) in this study.