CLINICAL PROFILE AND OUTCOME OF EMPYEMA IN CHILDREN

Department of Paediatrics,CHRISTIAN MEDICAL COLLEGE Abstract : AIM To identify the optimal scheme of management of empyema in children based on ultrasound findings. METHODS A total of 82 children below the age of 15 years with empyema admitted to Paediatric and Paediatric Surgery wards between 2004 and 2008 were reviewed retrospectively.RESULTS 48.8 percentage of the children were in the age group of 1-5 years and were predominantly males. The four most common symptoms at admission were fever, cough, breathlessness and chest pain. Pleural fluid culture was done in 63 out of 82 children with empyema. Of these only 16(25 percentage) had positive culture. Commonest cause of empyema that was proven by culture was staphylococcus aureus contributing to 19 percentage of all the pleural fluid cultures. Chest X-ray was done on all children and all of them had features consistent with pleural effusion. Ultrasound examination was done in 34 out of 82 children. 6 out of 34(18 percentage) ultrasound done at admission and the rest had it after closed thoracotomy. Based on the ultrasound findings, empyema was classified into low grade and high grade categories. Low grade included those with no loculation or a single loculation whereas high grade included multiloculation and pleural thickening. 67.6 percentage were low grade and the rest being high grade. Most of the children who had direct decortication had high grade ultrasound findings (66 percentage vs 33 percentage). All the children who had IV antibiotics only had low grade ultrasound findings.