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Paediatric empyema: worsening disease severity and challenges identifying patients at increased risk of repeat intervention
  1. Stuart Haggie1,
  2. Hasantha Gunasekera2,
  3. Chetan Pandit3,
  4. Hiran Selvadurai3,
  5. Paul Robinson3,
  6. Dominic A Fitzgerald3
  1. 1 Children's Hospital at Westmead, Westmead, New South Wales, Australia
  2. 2 Department of Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, Australia
  3. 3 Department of Respiratory Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
  1. Correspondence to Dr Stuart Haggie, The Children's Hospital Westmead, Children's Hospital at Westmead, Westmead, NSW 2145, Australia; stuart.haggie{at}


Objective Empyema is the most common complication of pneumonia. Primary interventions include chest drainage and fibrinolytic therapy (CDF) or video-assisted thoracoscopic surgery (VATS). We describe disease trends, clinical outcomes and factors associated with reintervention.

Design/setting/patients Retrospective cohort of paediatric empyema cases requiring drainage or surgical intervention, 2011–2018, admitted to a large Australian tertiary children’s hospital.

Results During the study, the incidence of empyema increased from 1.7/1000 to 7.1/1000 admissions (p<0.001). We describe 192 cases (174 CDF and 18 VATS), median age 3.0 years (IQR 1–5), mean fever duration prior to intervention 6.2 days (SD ±3.3 days) and 50 (26%) cases admitted to PICU. PICU admission increased during the study from 18% to 34% (p<0.001). Bacteraemia occurred in 23/192 (12%) cases. A pathogen was detected in 131/192 (68%); Streptococcus pneumoniae 75/192 (39%), S. aureus 25/192 (13%) and group A streptococcus 13/192 (7%). Reintervention occurred in 49/174 (28%) and 1/18 (6%) following primary CDF and VATS. Comparing repeat intervention with single intervention cases, a continued fever postintervention increased the likelihood for a repeat intervention (OR 1.3 per day febrile; 95% CI 1.2 to 1.4, p<0.0001). Younger age, prolonged fever preintervention and previous antibiotic treatment were not associated with initial treatment failure (all p>0.05).

Conclusion We report increasing incidence and severity of empyema in a large tertiary hospital. One in four patients required a repeat intervention after CDF. Neither clinical variables at presentation nor early investigations were able to predict initial treatment failure.

  • general paediatrics
  • respiratory
  • infectious diseases

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  • Contributors SH is the primary author and is responsible for the study design, analysis, writing and revision of the manuscript. All coauthors (HG, CP, PR, DAF and HS) were substantially involved in designing the study, analysis the results, writing and revising the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Relevant data included in this manuscript.