Objective: To determine the clinical presentation and treatment strategies
for children admitted with pleural empyema.
Methodology: Retrospective review of medical and radiological records of 54
patients admitted with pleural empyema between January 1989 and April 1997
.
Results: Fever (98%), cough (83%), chest pain (38%), clinical cyanosis (17%
) and abdominal pain (16%) were common clinical features. The causative org
anism was identified in 17 patients (31%). Intravenous antibiotics were giv
en for a mean of 18.2 +/- 7.5 days. Forty-seven (87%) patients had closed c
hest tube drainage and 21(39%) patients underwent decortication for unsatis
factory response to medical treatment. The chest tube insertion was more li
kely to be delayed in patients who required decortication, although the dif
ference was not significant (8.1 +/- 5.4 vs 6.3 +/- 5.2 days of illness, P
= 0.67). All patients were discharged well, with almost complete resolution
of the chest radiograph at 6 months.
Conclusions: Intensive medical management with adequate chest tube drainage
and appropriate antibiotics will result in full resolution for most patien
ts. Surgical intervention is important in patients who fail to receive adeq
uate treatment early in the disease.