Scoring system for empyema thoracis and help in management

K. S. Wong, T. Y. Lin, Y. C. Huang, L. Y. Chang, S. H. Lai

研究成果: 雜誌貢獻文章

28 引文 (Scopus)

摘要

Objective : To evaluate the implications of a newly defined severity scoring of empyema in children for the prediction of surgical management and to compare the length of hospitalization as an outcome measure of patients treated using medical therapy, salvage video-assisted thoracoscopic surgery (VATS) vs early elective VATS. Methods : A retrospective chart review of parapneumonic empyema of patients below 18 years of age admitted to a tertiary children's hospital in northern Taiwan from April 1993 to December 2002 was performed. Patients were categorized into a medical group who received antibiotic therapy, needle aspirations with/without tube thoracostomy; a salvage VATS group when the patients required surgery for the relief of persistent fever > 38°C, chest pains or dyspneic respirations despite initial medical therapy; an early VATS group when the patients received elective surgery early after admission. The demographic data, clinical features, laboratory findings, and duration of hospitalization were compared using a severity score of empyema (SSE). Results : Streptococcus pneumoniae was the most common infecting organism, followed by Staphylococcus aureus, Pseudomonas aeruginosa. No organisms were recovered in 39% of patients. A pleural pH < 7.1 increases the odds of requiring surgical intervention by 6 times among this cohort. Children who required decortication of empyema had a higher severity score (mean 4.8 vs 3.0, p < 0.005). The duration of hospitalization for patients having early VATS showed a shortening stay (mean 18 vs 28 days) as compared to salvage VATS. Conclusion : A pleural pH < 7.1 and a newly designed clinical severity score of empyema ≥ 4 are two predictors of surgical intervention for fibrinopurulent empyema in the present study. Early elective VATS may be adopted not later than 7 days after failure of appropriate antibiotic therapy and adequate drainage of empyema to decrease the length of stay and minimize morbidity.
原文英語
頁(從 - 到)1025-1028
頁數4
期刊Indian Journal of Pediatrics
72
發行號12
DOIs
出版狀態已發佈 - 十二月 2005
對外發佈Yes

指紋

Video-Assisted Thoracic Surgery
Empyema
Hospitalization
Thoracostomy
Anti-Bacterial Agents
Salvage Therapy
Streptococcus pneumoniae
Chest Pain
Taiwan
Tertiary Care Centers
Pseudomonas aeruginosa
Needles
Staphylococcus aureus
Drainage
Length of Stay
Respiration
Fever
Therapeutics
Demography
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

引用此文

Scoring system for empyema thoracis and help in management. / Wong, K. S.; Lin, T. Y.; Huang, Y. C.; Chang, L. Y.; Lai, S. H.

於: Indian Journal of Pediatrics, 卷 72, 編號 12, 12.2005, p. 1025-1028.

研究成果: 雜誌貢獻文章

Wong, KS, Lin, TY, Huang, YC, Chang, LY & Lai, SH 2005, 'Scoring system for empyema thoracis and help in management', Indian Journal of Pediatrics, 卷 72, 編號 12, 頁 1025-1028. https://doi.org/10.1007/BF02724404
Wong, K. S. ; Lin, T. Y. ; Huang, Y. C. ; Chang, L. Y. ; Lai, S. H. / Scoring system for empyema thoracis and help in management. 於: Indian Journal of Pediatrics. 2005 ; 卷 72, 編號 12. 頁 1025-1028.
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AB - Objective : To evaluate the implications of a newly defined severity scoring of empyema in children for the prediction of surgical management and to compare the length of hospitalization as an outcome measure of patients treated using medical therapy, salvage video-assisted thoracoscopic surgery (VATS) vs early elective VATS. Methods : A retrospective chart review of parapneumonic empyema of patients below 18 years of age admitted to a tertiary children's hospital in northern Taiwan from April 1993 to December 2002 was performed. Patients were categorized into a medical group who received antibiotic therapy, needle aspirations with/without tube thoracostomy; a salvage VATS group when the patients required surgery for the relief of persistent fever > 38°C, chest pains or dyspneic respirations despite initial medical therapy; an early VATS group when the patients received elective surgery early after admission. The demographic data, clinical features, laboratory findings, and duration of hospitalization were compared using a severity score of empyema (SSE). Results : Streptococcus pneumoniae was the most common infecting organism, followed by Staphylococcus aureus, Pseudomonas aeruginosa. No organisms were recovered in 39% of patients. A pleural pH < 7.1 increases the odds of requiring surgical intervention by 6 times among this cohort. Children who required decortication of empyema had a higher severity score (mean 4.8 vs 3.0, p < 0.005). The duration of hospitalization for patients having early VATS showed a shortening stay (mean 18 vs 28 days) as compared to salvage VATS. Conclusion : A pleural pH < 7.1 and a newly designed clinical severity score of empyema ≥ 4 are two predictors of surgical intervention for fibrinopurulent empyema in the present study. Early elective VATS may be adopted not later than 7 days after failure of appropriate antibiotic therapy and adequate drainage of empyema to decrease the length of stay and minimize morbidity.

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KW - Severity scoring

KW - Video-assisted thoracoscopic surgery

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