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Treatment Trends and Outcomes in US Hospital Stays of Children With Empyema

Kelly, Michelle M. MD*; Shadman, Kristin A. MD*; Edmonson, M. Bruce MD, MPH

The Pediatric Infectious Disease Journal: May 2014 - Volume 33 - Issue 5 - p 431–436
doi: 10.1097/INF.0000000000000131
Original Studies

Background: Recently published practice guidelines continue to reflect uncertainty about the comparative effectiveness of various treatments for empyema in children. We describe treatment trends and outcomes in pediatric empyema using the most current nationally representative data.

Methods: Using survey methods and Kids’ Inpatient Databases from 1997 to 2009, we evaluated hospital stays in children 0–18 years of age. We used 2009 data to compare transfer-out rates and lengths of stay across various types of treatment, after adjusting for patient and hospital factors.

Results: From 1997 to 2009, empyema discharges steadily increased from 3.1 to 6.0 per 100,000 children (P < 0.001 for trend) and also were increasingly likely (P < 0.01) to be coded for: (1) at least 1 pleural drainage procedure (76.4–83.2%), (2) multiple drainage procedures (36.0–41.6%) and (3) home health care (8.7–15.0%). By 2009, video-assisted thoracoscopic surgery was more commonly coded than chest tube drainage and was associated with a lower transfer-out rate (0.6% vs. 10.1%, adjusted P < 0.001) but no reduction in mean length of stay [11.2 vs. 13.4 days, adjusted incidence rate ratio 0.95 (95% confidence interval: 0.88–1.04)] for children neither admitted nor discharged by transfer.

Conclusions: US hospital stays for empyema in children not only continued to increase through 2009 but were also characterized by more intense procedural management. Outcomes results in this population-based study are consistent with practice guidelines and recommendations that recently endorsed chest tube drainage as an acceptable first treatment option for most children with empyema.

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From the *Divisions of Hospital Medicine; and General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI.

Accepted for publication October 11, 2013.

The authors have no funding and conflicts of interest to disclose.

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Address for correspondence: Michelle M. Kelly, MD, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, CSC 4108, 600 Highland Ave., Madison, WI 53792. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc.