@article {Haggiearchdischild-2019-318219, author = {Stuart Haggie and Hasantha Gunasekera and Chetan Pandit and Hiran Selvadurai and Paul Robinson and Dominic A Fitzgerald}, title = {Paediatric empyema: worsening disease severity and challenges identifying patients at increased risk of repeat intervention}, elocation-id = {archdischild-2019-318219}, year = {2020}, doi = {10.1136/archdischild-2019-318219}, publisher = {BMJ Publishing Group Ltd}, abstract = {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{\textendash}2018, admitted to a large Australian tertiary children{\textquoteright}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{\textendash}5), mean fever duration prior to intervention 6.2 days (SD {\textpm}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.}, issn = {0003-9888}, URL = {https://adc.bmj.com/content/early/2020/03/24/archdischild-2019-318219}, eprint = {https://adc.bmj.com/content/early/2020/03/24/archdischild-2019-318219.full.pdf}, journal = {Archives of Disease in Childhood} }