G97 PARAPNEUMONIC EFFUSION AND EMPYEMA: THE EXPERIENCE OF 101 CASES IN ONE CENTRE

N. Barnes, J. Hull, A. Thomson. Department of Paediatrics, John Radcliffe Hospital, Oxford, UK

Introduction: Considerable heterogeneity exists in the management of parapneumonic effusion and empyema both within and between centres in the UK. Our unit first line management comprises intravenous antibiotic therapy with chest tube drainage and intra-pleural fibrinolysis, with surgery reserved for those children who subsequently fail to improve.

Methods: A retrospective database analysis of the management of all children with parapneumonic effusion and empyema admitted to the John Radcliffe Hospital over a 7 year period, 1996–2003.

Results: 101 children were admitted. 10 were excluded as they were part of a multicentre RCT and had received intra-pleural saline instead of urokinase. Of the remaining 91, 47 were female and 44 male. Median age on admission was 5.8 years (range 0.3–14.0). Symptoms pre-admission averaged 11 days, with February the commonest month for presentation. 79 underwent chest ultrasound, confirming an effusion in all, described as loculated/septated (58) or echogenic (9). In 12 cases no specific comment was made regarding the nature of the fluid seen on ultrasound. 87 had subsequent chest tube drainage and then received intra-pleural fibrinolysis with urokinase. An aetiological organism was identified in 20 cases (22%) (Streptococcus pneumoniae (9), group A streptococcus (5), Staphylococcus aureus (4), Haemophilus influenzae (1), coliform (1)). In a further eight cases (9%), Gram positive organisms were seen on pleural fluid microscopy but did not grow on culture. Two (2%) required surgery when medical management had failed. Median duration of admission was 7 days (range 2–21 days); median duration of stay from intervention was 5 days (range 2–19 days). At follow up all children were symptom free with minimal pleural thickening on chest x ray.

Conclusion: Antibiotic therapy with chest drain insertion and intra-pleural urokinase is effective in treating empyema and …