Published online June 1, 2005
PEDIATRICS Vol. 115 No. 6 June 2005, pp. 1652-1659 (doi:10.1542/peds.2004-1405)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via ISI Web of Science (23)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Avansino, J. R.
Right arrow Articles by Flum, D. R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Avansino, J. R.
Right arrow Articles by Flum, D. R.
Related Collections
Right arrow Therapeutics & Toxicology

Primary Operative Versus Nonoperative Therapy for Pediatric Empyema: A Meta-analysis

Jeffrey R. Avansino, MD{ddagger}, Bryan Goldman, MS§, Robert S. Sawin, MD{ddagger},|| and David R. Flum, MD, MPH{ddagger},¶

{ddagger} Surgery
§ Biostatistics
Health Services, University of Washington, Seattle, Washington
|| Department of Surgery, Children’s Hospital and Regional Medical Center, Seattle, Washington

Objective. The optimal treatment of children with empyema remains controversial. The purpose of this review was to compare reported results of nonoperative and primary operative therapy for the treatment of pediatric empyema.

Methods. A systematic comprehensive review of the scientific literature was conducted with the PubMed (National Library of Medicine) database for the period from 1981 to 2004. This reproducible search identified all publications dealing with treatment of empyema in the pediatric population (<18 years of age). A meta-analysis was performed with studies with adequate data summaries for ≥1 of the outcomes of interest for both treatment groups.

Results. Sixty-seven studies were reviewed. Data were aggregated from reports of children initially treated nonoperatively (3418 cases from 54 studies) and of children treated with a primary operative approach (363 cases from 25 studies). The populations were similar in age. Patients who underwent primary operative therapy had a lower aggregate in-hospital mortality rate (0% vs 3.3%), reintervention rate (2.5% vs 23.5%), length of stay (10.8 vs 20.0 days), duration of tube thoracostomy (4.4 vs 10.6 days), and duration of antibiotic therapy (12.8 vs 21.3 days), compared with patients who underwent nonoperative therapy. In 8 studies for which meta-analysis was possible, patients who received primary operative therapy were found to have a pooled relative risk of failure of 0.09, compared with those who did not. Meta-analysis could not be performed for any of the other outcome measures investigated in this review. Similar complication rates were observed for the 2 groups (5% vs 5.6%).

Conclusions. These aggregate results suggest that primary operative therapy is associated with a lower in-hospital mortality rate, reintervention rate, length of stay, time with tube thoracostomy, and time of antibiotic therapy, compared with nonoperative treatment. The meta-analysis demonstrates a significantly reduced relative risk of failure among patients treated operatively.

Key Words: empyema • treatment • video-assisted thoracoscopic surgery • thrombolytics • thoracotomy

Abbreviations: VATS, video-assisted thoracoscopic surgery • MeSH, Medical Subjects Heading

Accepted Jan 18, 2005.




This article has been cited by other articles:


Home page
 Arch Pediatr Adolesc MedHome page
S. S. Shah, C. M. DiCristina, L. M. Bell, T. Ten Have, and J. P. Metlay
Primary Early Thoracoscopy and Reduction in Length of Hospital Stay and Additional Procedures Among Children With Complicated Pneumonia: Results of a Multicenter Retrospective Cohort Study
Arch Pediatr Adolesc Med, July 1, 2008; 162(7): 675 - 681.
[Abstract] [Full Text] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
S.-T. T. Li and R. L. Gates
Hold Those Scalpels--Reply
Arch Pediatr Adolesc Med, July 1, 2008; 162(7): 698 - 699.
[Full Text] [PDF]

Home page
 Pediatr. Rev.Home page
W. J. Durbin and C. Stille
Pneumonia
Pediatr. Rev., May 1, 2008; 29(5): 147 - 160.
[Full Text] [PDF]

Home page
 PediatricsHome page
E. Cohen, M. Weinstein, and D. N. Fisman
Cost-effectiveness of Competing Strategies for the Treatment of Pediatric Empyema
Pediatrics, May 1, 2008; 121(5): e1250 - e1257.
[Abstract] [Full Text] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
S.-T. T. Li and R. L. Gates
Primary Operative Management for Pediatric Empyema: Decreases in Hospital Length of Stay and Charges in a National Sample
Arch Pediatr Adolesc Med, January 1, 2008; 162(1): 44 - 48.
[Abstract] [Full Text] [PDF]

Home page
 CLIN PEDIATRHome page
R. Padman, K. A. King, S. Iqbal, and P. J. Wolfson
Parapneumonic Effusion and Empyema in Children: Retrospective Review of the duPont Experience
Clinical Pediatrics, July 1, 2007; 46(6): 518 - 522.
[Abstract] [PDF]

Home page
 PediatricsHome page
B. A. Kurt, K. M. Winterhalter, R. H. Connors, B. W. Betz, and J. W. Winters
Therapy of Parapneumonic Effusions in Children: Video-Assisted Thoracoscopic Surgery Versus Conventional Thoracostomy Drainage
Pediatrics, September 1, 2006; 118(3): e547 - e553.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
P. Mattei and J. L. Allen
Treatment of Empyema in Children: From Hippocrates' Time to the Present, and Back Again
Am. J. Respir. Crit. Care Med., July 15, 2006; 174(2): 110 - 111.
[Full Text] [PDF]

Home page
 PediatricsHome page
R. Roseby
Primary Operative Versus Nonoperative Therapy for Pediatric Empyema
Pediatrics, April 1, 2006; 117(4): 1462 - 1463.
[Full Text] [PDF]

Home page
 PediatricsHome page
C.W. Bollen, M.O. Hoekstra, and H.G.M. Arets
Pooling of Studies in Meta-analysis of Observational Research Leads to Precise but Spurious Results
Pediatrics, January 1, 2006; 117(1): 261 - 262.
[Full Text] [PDF]

Home page
 AAP Grand RoundsHome page
C. Cavett
Pediatric Empyema: Operative versus Nonoperative Primary Therapy
AAP Grand Rounds, October 1, 2005; 14(4): 40 - 40.
[Full Text] [PDF]