Management of Childhood Empyema as a Complication of Community Acquired Pneumonia

Abstract
Background: Pneumonia is one of the most common reasons for hospitalization in childhood. Although most bacterial pneumonia will resolve with treatment of the under-lying infection, some cases will be complicated by the devel-opment of an empyema.
Aim of Study: To assess the degree of agreement of the lines of diagnosis and treatment of patients with complicated pneumonia and empyema with the European guidelines for management of childhood empyema.
Patients and Methods: This study is a prospective analysis of 60 patients of empyema that were diagnosed and managed at Assuit University Children Hospital over 12 months from 1st March 2016-28th February 2017.
Results: History of prolonged pneumonic illness (>15 days) and pleuritic pain were checked in 100% and 86.7% respectively. History of the cardinal signs (cough, fever and respiratory distress) and investigations as CXR, WBC count, blood culture, CRP and ESR of community acquired pneumo-nia was taken in 100%, 100%, 100%, 75%, 41.7% and 41.7% respectively. ELISA test and procalcitonin were not done in any of our patients. History of the lines of management of community acquired pneumonia was taken in 60% of patients. Investigations of empyema as CXR, chest CT scan, analysis of pleural fluid, chest ultrasound, sputum culture were done in 100%, 100%, 75%, 21.7, 8.3% successively. Eighty five % were treated correctly by antibiotics and 65%operated on by chest tube drainage and 1.6% was operated upon by open thoracotomy with decortications. Fibrinolytic therapy was not done in any of our patients.
Conclusion: Empyema is still a respiratory problem in pediatrics. Evaluation of the studied patients were done perfectly except for some history points and some laboratory investigations that showed some defects. Management was perfectly done except for fibrinolytic therapy.