Assessment of the burden of paediatric empyema in Australia

Aims: To investigate the change in incidence of childhood empyema and pneumonia in Australia, and ascertain the management trends in all hospitals caring for children with empyema. Methods: The incidences of empyema and pneumonia were calculated for each year between 1993/1994 and 2004/2005 using retrospective primary diagnostic coding from ICD-9 and 10 comprising the Australian National Hospital Morbidity Database for five age groups in patients less than 20 years of age. Hospitals with allocated paediatric beds were surveyed on referral pattern and treatment preferences. Results: In this study, 145 562 patients with pneumonia were admitted with a mean (range) incidence of 2306 (1846-2652) per million. The trend towards an overall increase was not statistically significant. Only the 1-4 years old age group demonstrated a significant increase (P < 0.01, r(2) = 0.61). A total of 469 cases of empyema were identified with a mean incidence of 7.35 (4-10.2) per million. There was an overall increase in incidence (P < 0.05, r(2) = 0.51) reflecting an increase in the 1- to 4-year-olds (P < 0.005, r(2) = 0.60) and 15- to 19-year-olds (P < 0.05, r(2) = 0.37). The overall percentage of empyema as a proportion of pneumonia increased from 0.27 to 0.70% (0.48% (0.27-0.70%), P < 0.05, r(2) = 0.38). The survey response rate was 75%. Ninety-nine of 121 (82%) hospitals referred children with empyema to a more appropriate centre with wide variations in treatments provided. Conclusions: The rise in incidence of empyema reflects that seen in other countries. Furthermore, there are diverse management practices suggesting a clear need for national guidelines.