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Category: Volume 07 Issue 04 April 2019
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Title: Predictors of Outcome after Surgical Intervention of Empyema Thoracis in Pediatric Age Group

Authors: Dr Shipra Sharma, Dr Nitin Sharma, Dr Aditya Kekti

 DOI: https://dx.doi.org/10.18535/jmscr/v7i4.160

Abstract

Background: Childhood empyema is important complication of bacterial pneumonia. It is observed 3.3 per 1 LAC Children affected by empyema thoracis that is 0.6% of childhood pneumonia progresses to empyema. Treatment options for empyema are antibiotics alone or in combination with chest tube drainage, Intrapleural fibrinolytics, video assisted thoracoscopic surgery (VATS) and open decortications.

Methods: This was a prospective observational study, conducted in the department of pediatric surgery of Dr.B.R.A.M. Hospital Raipur C.G from July2017-August2018. All children in age group of 0 days to 17 years diagnosed with empyema during the study period were included in the study.  Patient who were not giving consent for the study, malignancy, congenital lung or heart anomalies, traumatic empyema, were excluded.

Results: Twenty-three cases of empyema (0 to 17 years) were recorded during the study period. Youngest patient was 6 month and eldest was 13year. 15 (65.2%) were male and 8 (34.8%) patients were female. Chest involvement 15 (65%) patients had right side, 7 (31%) had left sided and 1 (4%) patient was found bilateral disease. All the patients (100%) presented with fever and cough, on investigation 7 (30.4%) patients had anaemia. In X ray chest Pleural effusion was seen in 23(100%) patient, Pyopneumothorax in 8 patients, overcrowding of rib in 15 patients and 18 patients had mediastinal shift. Scoliosis and clear lung field was not seen in any patients. In USG pleural effusion was seen in 23(100%) patients, and 7 patients presented with Pyopneumothorax. Pus culture was sterile in 18/23(78.3%) cases, Staphylococcus was found in 4/23(17.4%) and pseudomonas in 1/23(4.3%) case. Blood culture was sterile in 19/23(82.6%) cases, Coagulase negative staphylococcus aureus 3/23 (13.0%), pseudomonas and citrobacteria both were counted in 1/23 (4.2%) case. 12(52%) patients underwent open decortication, 9(39%) primary thoracostomy and 2(9%) underwent primary VATS.

Conclusion: In this study Association was seen between the duration of disease, age and nutritional status (BMI and Preoperative Albumin level) of empyema patient with clinical and radiological outcome of empyema thoracis and I found statically significant association between pleural thickening with BMI and preoperative albumin level in postoperative period and 2 week follow up. I recommended detailed focused study to verify and validate my observation.

Keywords: pediatric empyema, thoracotomy, pleural thickening, staphylococcus aureus, Pyopneumothorax

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Corresponding Author

Dr Aditya Kekti

Address: Pt. JNM Medical College, Jail road Raipur (C.G.) Pin Code- 492001, India

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