Development of parapneumonic empyema in children

• Published in: Acta Paediatrica Vol. 96; no. 11; pp. 1686 - 1692
• Main Authors: Lahti, Elina, Peltola, Ville, Virkki, Raimo, Alanen, Markku, Ruuskanen, Olli
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.11.2007; Blackwell
• Subjects: Adolescent; Biological and medical sciences; C-Reactive Protein - analysis; Child; Child, Preschool; Children; Community-Acquired Infections - complications; Community-Acquired Infections - diagnosis; Community-Acquired Infections - epidemiology; Complicated pneumonia; Diagnosis, Differential; Disease Progression; Empyema; Empyema, Pleural - diagnosis; Empyema, Pleural - epidemiology; Empyema, Pleural - microbiology; Empyema, Pleural - pathology; Female; Finland - epidemiology; General aspects; Humans; Incidence; Infant; Male; Medical Records; Medical sciences; Multivariate Analysis; Parapneumonic effusion; Pneumonia; Pneumonia, Bacterial - complications; Pneumonia, Bacterial - diagnosis; Pneumonia, Bacterial - epidemiology; Retrospective Studies; Risk Factors; Finland; Human; Lung disease; Pediatrics; Pneumonia; Effusion; Respiratory disease; Parapneumonic effusion; Complicated pneumonia; Pleural empyema; Development; Complication; Empyema; Children; Child
• ISSN: 0803-5253; 1651-2227
• DOI: 10.1111/j.1651-2227.2007.00511.x

Aim: The aim of the study was to find clinical predictors for parapneumonic empyema in children. Methods: Thirty‐seven children treated for parapneumonic empyema at the Department of Pediatrics, Turku University Hospital, were retrospectively evaluated. Two distinct comparison groups of children with uncomplicated community‐acquired pneumonia with alveolar consolidation (n = 37 in both groups) were included. Clinical and laboratory data on admission as well as fever kinetics and inflammatory markers during hospitalization were analyzed. Results: In a multivariate analysis, a history of prolonged fever, tachypnoea and pain on abdominal palpation on admission were the most significant clinical predictors for empyema. On admission, serum C‐reactive protein levels were higher among children with empyema than among those with uncomplicated pneumonia (means, 234 mg/L vs. 178 mg/L; p = 0.037). During hospitalization, prolonged fever and persistence of high serum C‐reactive protein levels were associated with empyema. At the initial evaluation, pleural fluid was not reported in 35% of children with empyema. Conclusions: Early recognition of developing empyema is challenging. Children with pneumonia presenting with prolonged fever, tachypnoea, pain on abdominal palpation and high serum C‐reactive protein levels are at risk for parapneumonic empyema.