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Nov 2012

The Long-term Outcomes of Pediatric Pleural Empyema: A Prospective Study

Author Affiliations

Author Affiliations: Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine (Drs Cohen, Mahant, Ragone, and Weinstein), Division of Respiratory Medicine (Dr Dell), Division of Infectious Diseases, (Dr Wadhwa), Department of Pediatrics; Department of Diagnostic Imaging (Drs Traubici and Connolly); Child Health Evaluative Sciences, Research Institute (Drs Cohen, Mahant, Dell, and Weinstein), The Hospital for Sick Children; and Institute for Health Policy, Management, and Evaluation (Drs Cohen and Dell), University of Toronto, Canada.

Arch Pediatr Adolesc Med. 2012;166(11):999-1004. doi:10.1001/archpediatrics.2012.1055

Objective To describe the long-term outcomes of pediatric pleural empyema.

Design Prospective observational study from October 2008 to October 2011.

Setting Tertiary care children's hospital.

Participants Children with pleural empyema (loculations and/or septations identified on radiologic imaging or frank pus on thoracentesis).

Main Outcome Measures Children were seen 1, 6, and 12 months postdischarge. Outcome measures included symptoms and signs of respiratory disease, child and parental impact, radiographic resolution, spirometry, and health-related quality of life (Pediatric Quality of Life Inventory score). Analysis was based on the last observation carried forward for missing data.

Results Eighty-two of 88 patients (93%) eligible were recruited. Fifty-four percent were male and mean (SD) age was 4.5 (3.4) years. Outcome data was obtained in 100% at 1 month, 90% at 6 months, and 72% at 1 year. Seventy-one percent had effusions occupying a quarter or more of the hemithorax and 62% of effusions were drained. Fever, cough, parental work loss, child school loss, radiographic abnormalities, and abnormal spirometry results were common in the first month and then declined. By the last observation, 2% of patients had abnormal radiographs (aside from pleural thickening), 6% had mild obstruction on spirometry, and Pediatric Quality of Life Inventory scores were better than for children with asthma (P < .001). Patients with abnormal outcomes in 1 measure had normal outcomes in all other clinical measures.

Conclusions Clinically important phenomena persist in the short-term, but virtually all children with pleural empyema have no long-term sequelae.