Title : Epidemiological profile, diagnosis, and treatment of pleural empyema in pediatric population treated at a tertiary hospital in Brazil
Abstract:
Introduction: The complicated parapneumonic pleural effusion (CPPE), or empyema, stands for an important pneumonia’s complication in pediatric population, being associated to higher hospitalization and the need to surgical approach. Current medical literature describes higher incidence in younger patients, especially between 1 and 9 years old, most occurring in winter months. This article’s goal was to describe the epidemiology, diagnosis, treatment and outcome in CPPE in children admitted in a public tertiary hospital in Brazil, during 2022 to 2024.
Methodology: A cross-sectional, retrospective study analyzing medical records of children aged 0 to 15 years diagnosed with CPPE and followed by the thoracic surgery service from January 2022 to December 2024. Demographic data, diagnostic tests performed, treatment modalities used, average length of hospital stay, and mortality rates were collected. A descriptive analysis was performed.
Results: A total of 110 children with CPPE (31 in 2022, 29 in 2023, and 50 in 2024) were identified during the study period. A similar distribution by sex was observed across the three years studied. The most affected pediatric age group was 1 to 5 years old in all years analyzed. Seasonality was observed, with a higher number of cases in the winter months, averaging 15 diagnoses from May to August in each year analyzed. Chest X-ray was the primary diagnostic test (95 children), followed by computed tomography (4 children) and pulmonary ultrasound, the last showing a progressive increase in use over the years, rising from 3 cases in 2022 to 6 in 2024. All patients underwent some kind of intervention in addition to antibiotic therapy. In 2022 and 2023, the primary treatment modality was videoassisted thoracoscopic (VATS) (51.6% and 55.1%, respectively), followed by chest tube drainage. In 2024, however, the most common treatment was closed pleural drainage (56%), followed by VATS (42%). In the year 2023 occurred the highest number of surgeries (VATS and thoracotomy), with 63% of children undergoing some form of intervention, and it was also the period during which no deaths were observed. A progressive reduction in the average length of hospital stay was observed, from 22 days in 2022 to 15 days in 2024. Mortality was low, ranging from 0% to 6%.
Conclusion: It is observed that the seasonality of empyema tends to follow a bimodal pattern, with one peak during the winter months and another during the transition from spring to summer. Furthermore, it is noted that advances in diagnostic methods and surgical approaches have contributed to a reduction in morbidity, particularly through the use of less invasive methods. These data are important for justifying the importance of investing in new technologies and in the training of professionals, especially surgeons, to enable appropriate diagnosis and treatment.
