Are some children with empyema at risk for treatment failure with fibrinolytics? A multicenter cohort study
Autor: | Andreana Bütter, Eyal Cohen, Michael H. Livingston, Niraj Mistry, Lucy Giglia, Sanjay Mahant, David Pirrello, Sharifa Himidan, Michael Weinstein, Bairbre Connolly, J. Mark Walton |
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Rok vydání: | 2016 |
Předmět: |
Male
medicine.medical_specialty Cohort Studies 03 medical and health sciences Sex Factors 0302 clinical medicine Risk Factors 030225 pediatrics White blood cell Intensive care Internal medicine London medicine Humans Thrombolytic Therapy Treatment Failure 030212 general & internal medicine Child Empyema Pleural Retrospective Studies Univariate analysis medicine.diagnostic_test Platelet Count business.industry Retrospective cohort study General Medicine Odds ratio Length of Stay Hospitals Pediatric medicine.disease Empyema Surgery medicine.anatomical_structure Chest Tubes Child Preschool Erythrocyte sedimentation rate Pediatrics Perinatology and Child Health Drainage Female business Cohort study |
Zdroj: | Journal of Pediatric Surgery. 51:832-837 |
ISSN: | 0022-3468 |
Popis: | Background Guidelines recommend that children with empyema be treated initially with chest tube insertion and intrapleural fibrinolytics. Some patients have poor outcomes with this approach, and it is unclear which factors are associated with treatment failure. Methods Possible risk factors were identified through a review of the literature. Treatment failure was defined as need for repeat pleural drainage and/or total length of stay greater than 2weeks. Results We retrospectively identified 314 children with empyema treated with fibrinolytics at The Hospital for Sick Children (2000–2013, n =195), Children's Hospital, London Health Sciences Centre (2009–2013, n =39), and McMaster Children's Hospital (2007–2014, n =80). Median length of stay was 11days (range 5–69days). Thirteen percent of children required repeat drainage procedures, and 34% experienced treatment failure. There were no deaths. White blood cell count, erythrocyte sedimentation rate, C-reactive protein, albumin, urea to creatinine ratio, and signs of necrosis on initial chest x-ray were not associated with treatment failure. Multivariable logistic regression demonstrated increased risk with positive blood culture (odds ratio=2.7), immediate admission to intensive care (odds ratio=2.6), and absence of complex septations on baseline ultrasound (odds ratio=2.1). Male gender and platelet count were associated with treatment failure in the univariate analysis but not in the multivariable model. Conclusions Predicting which children with empyema are at risk for treatment failure with fibrinolytics remains challenging. Risk factors include positive blood culture, immediate admission to intensive care, and absence of complex septations on ultrasound. Routine blood work and inflammatory markers have little prognostic value. |
Databáze: | OpenAIRE |
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