Elsevier

Journal of Pediatric Surgery

Volume 47, Issue 11, November 2012, Pages 2101-2110
Journal of Pediatric Surgery

Review Article
The diagnosis and management of empyema in children: a comprehensive review from the APSA Outcomes and Clinical Trials Committee

https://doi.org/10.1016/j.jpedsurg.2012.07.047Get rights and content

Abstract

The aim of this study is to review the current evidence on the diagnosis and management of empyema. The American Pediatric Surgical Association Outcomes and Clinical Trials Committee compiled 8 questions to address. A comprehensive review was performed on each topic. Topics included the distinction between parapneumonic effusion and empyema, the optimal imaging modality in evaluating pleural space disease, when and how pleural fluid should be managed, the first treatment option and optimal timing in the management of empyema, the optimal chemical debridement agent for empyema, therapeutic options if chemical debridement fails, therapy for parenchymal abscess or necrotizing pneumonia and duration of antibiotic therapy after an intervention. The evidence was graded for each topic to provide grade of recommendation where appropriate.

Section snippets

Methods

The APSA Outcomes and Clinical Trials Committee approved 8 questions that are salient to the management of pediatric empyema to address for this review. Literature searches were performed in English using Medline, PubMed, CINAHL, EMBASE and pertinent Cochrane reviews. Search terms were chosen by the author assigned to the specific section by utilizing multiple terms relevant to the topic addressed. Reference lists of relevant manuscripts were used to identify other relevant contributions.

Summary

This review summarizes the current state of knowledge regarding the management of parapneumonic effusion and empyema. Ultrasound should be the initial and primary imaging modality with CT reserved for more complicated cases such as determination of parenchymal disease and lung abscess (grade C). Pleural space fluid should be considered for evacuation with large effusions, effusions associated with loculations, and in moderate sized effusions in patients who fail to progress or have worsening

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