Managing Postpneumonic Empyema Thoracis in Children: Comparison of Different Treatment Options

Objectives: To compare various treatment methods of postpneumonic empyema (PPE) in children. Methods: Six hundred eighty one (302 females and 379 males) pediatric PPE patients were studied at two different centers between 2000 and 2016. The average age was 4.8 years that ranged from 30 days to 15 years. The patients were considered in six groups. The initial treatments, thoracentesis (group A), chest tube drainage (group B), fibrinolytic therapy (group C), decortication following chest tube drainage (group D), video-assisted thoracoscopic surgery (VATS) (group E) and primary operation without chest tube drainage (group F), were applied to the patients. Results: Success rates were 100%, 47.3%, 82.7%, 100%, 100%, and 100% for thoracentesis, chest tube drainage, fibrinolytic treatment, chest tube drainage, decortication following chest tube drainage, VATS and primer operation, respectively. The overall response rate of fibrinolytic therapy was 82.7% (n = 67). Fourteen of 81 (17.2%) patients who went through fibrinolytic instillation did not respond to treatment; these recovered after the application of thoracotomy and VATS. In addition to decortication pulmonary resections were performed in 15 patients. Overall mortality rate was 1.32%. There was no operative mortality. Postoperative morbidity included wound infection in 22, delayed expansion in 17, and atelectasis in 40 patients. Conclusions: Chest tube drainage can be said to be an efficient and safe primary treatment for PPE in children. In cases when chest tube drainage fails to satisfy, decortication with thoracotomy can be applied well with low mortality and morbidity rates.