Risk factors associated with adverse outcome in empyema thoracis children aged 1 month-12 years in a tertiary care centre: a nested case control study

Authors

  • Arunagirinathan V. Department of Pediatrics, Institute of Child Health and Hospital for Children, Egmore, Chennai, Tamil Nadu, India
  • Stalin S. Department of Pediatrics, Institute of Child Health and Hospital for Children, Egmore, Chennai, Tamil Nadu, India
  • Narayanan E. Department of Neonatology, Institute of Obstetrics and Gynecology and Hospital for Women and Children, Egmore, Chennai, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20172565

Keywords:

Complications, Empyema, Risk factors, Ultrasonogram, X-ray chest

Abstract

Background: Empyema thoracis (ET) is serious complication of pneumonia in children, treatment outcome depends upon many risk factors. Empyema thoracis is a serious infection of the pleural space. Despite the availability of broad spectrum antibacterial, improved vaccination coverage and better diagnostic tools, ET remains associated with high morbidity worldwide. This study was undertaken to identify risk factors associated with poor outcome and to describe etiological agents.

Methods: This nested case control study was conducted at Institute of Child Health and Hospital for Children, Egmore, and Chennai from January 2011 to October 2012 in age group from 1 month to 12 years attending with clinical/radiological evidence of empyema. Cases children with complications and controls without complications. Basic investigations, ultrasonogram chest, pleural fluid gram stain/ culture and blood culture done. Antibiotics started empirically and changed based on culture and sensitivity. Intercostal drainage (ICD) was inserted with an underwater seal.  Demographic data and other variables analysed were haemoglobin, persistent positive CRP, serum albumin level, pleural fluid gram stain, culture and sensitivity, imaging like ultra-sonogram, CECT, X-ray chest after ICD insertion.

Results: Of 90 empyema cases, 26 recovered without complication, 56 recovered with complication, 8 died. Logistic regression uses to find association between variables and complications. Risk factors significantly associated with complications were persistent positive CRP, pleural fluid gram stain, imaging ultra-sonogram chest showing loculations, CECT scan showing pleural thickening and X-ray chest after ICD insertion.

Conclusions: Independent risk factors associated with complications were X-ray chest after ICD insertion showing non-resolution, ultrasonogram revealing loculations and septations. Early diagnosis, appropriate antibiotics and timely intervention helps in reduction of empyema and complications.

References

Narayanappa D et al. Clinico-bacteriological profile and outcome of empyema. Indian Pediatr. 2013; 50:783-5.

Foglia RP, Randolph J. Current indications for decortication in the treatment of empyema in children. J Pediatr Surg 1987; 22: 28-33.

Robert M.Kliegman,MD et al Nelson Textbook of Pediatrics,19th Edition

Balfour-Lynn IM et al. BTS guidelines for the management of pleural infection in children. Thorax 2005;60 (Suppl 1):i1-21

Satpathy SK, Behera CK, Nanda P. Outcome of parapneumonic empyema. Indian J

Pediatr.2005; 72:195-9.

Muhammad Saleem, et al. Possible factors for predicting this Complication in Children with Community Acquired Bacterial pneumonia. Professional Med J Sep 2010;17(3):464-471

Menon P et al. Surgical management and outcome analysis of stage III pediatric empyema thoracis. J Indian Assoc Pediatr Surg. 2010; 15:9-14.

Shah K, Shaikh F, Poddutoor PK, et al. Clinical profile of empyema in tertiary health care centre. Indian J Child Health. 2015; 2(1):5-8.

Embyia et al, C-reactive protein: a sensitive marker in the management of treatment response in parapneumonic empyema of children. The Turkish Journal of Pediatrics 2003; 45: 311-314

Dilber E et al: C-reactive protein : a sensitive marker in the management of treatment response in parapneumonic empyema of children. Turk J Pediatr. 2003 Oct -Dec;45(4):311-4

Shahla Afsharpaiman Pleural Effusion in Children: A Review Article and Literature Review, International Journal of Medical Reviews, Volume 3, Issue 1, Winter 2016; 365-370

Dass R, et al. Empyema thoracis: analysis of 150 cases from a tertiary care centre in North East India. Indian J Pediatr. 2011 Nov; 78(11):1371-7.

Karen D. Schultz, et al. The Changing Face of Pleural Empyemas in Children: Epidemiology and Management. Pediatrics vol. 113 no.6 June 1, 2004 pp. 1735 – 1740

Givan DC, Eigen H. Common pleural effusions in children. Clin Chest Med. Jun 1998; 19(2):363-71.

Aquino SL, Webb WR, Gushiken BJ. Pleural exudates and transudates: diagnosis with contrast-enhanced CT. Radiology. Sep 1994; 192(3):803-8.

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Published

2017-06-21

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Original Research Articles