Journal
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE
Volume 166, Issue 11, Pages 999-1004Publisher
AMER MEDICAL ASSOC
DOI: 10.1001/archpediatrics.2012.1055
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Funding
- Dean's New Faculty Grant at the University of Toronto
- Pediatric Consultants Creative Professional Activity Grant at The Hospital for Sick Children
- Pediatric Outcomes Research Team (PORT) through the SickKids Foundation
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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.
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