The long-term outcomes of pediatric pleural empyema: a prospective study

Abstract

Objective: To describe the long-term outcomes of pediatric pleural empyema.

Design: Prospective observational study from October 2008 to October 2011.

Setting: Tertiary care children's hospital.

Participants: Children with pleural empyema (loculations and/or septations identified on radiologic imaging or frank pus on thoracentesis).

Main outcome measures: Children were seen 1, 6, and 12 months postdischarge. Outcome measures included symptoms and signs of respiratory disease, child and parental impact, radiographic resolution, spirometry, and health-related quality of life (Pediatric Quality of Life Inventory score). Analysis was based on the last observation carried forward for missing data.

Results: Eighty-two of 88 patients (93%) eligible were recruited. Fifty-four percent were male and mean (SD) age was 4.5 (3.4) years. Outcome data was obtained in 100% at 1 month, 90% at 6 months, and 72% at 1 year. Seventy-one percent had effusions occupying a quarter or more of the hemithorax and 62% of effusions were drained. Fever, cough, parental work loss, child school loss, radiographic abnormalities, and abnormal spirometry results were common in the first month and then declined. By the last observation, 2% of patients had abnormal radiographs (aside from pleural thickening), 6% had mild obstruction on spirometry, and Pediatric Quality of Life Inventory scores were better than for children with asthma (P < .001). Patients with abnormal outcomes in 1 measure had normal outcomes in all other clinical measures.

Conclusions: Clinically important phenomena persist in the short-term, but virtually all children with pleural empyema have no long-term sequelae.