Document Detail


Primary operative versus nonoperative therapy for pediatric empyema: a meta-analysis.
MedLine Citation:
PMID:  15930229     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The optimal treatment of children with empyema remains controversial. The purpose of this review was to compare reported results of nonoperative and primary operative therapy for the treatment of pediatric empyema. METHODS: A systematic comprehensive review of the scientific literature was conducted with the PubMed (National Library of Medicine) database for the period from 1981 to 2004. This reproducible search identified all publications dealing with treatment of empyema in the pediatric population (<18 years of age). A meta-analysis was performed with studies with adequate data summaries for > or =1 of the outcomes of interest for both treatment groups. RESULTS: Sixty-seven studies were reviewed. Data were aggregated from reports of children initially treated nonoperatively (3418 cases from 54 studies) and of children treated with a primary operative approach (363 cases from 25 studies). The populations were similar in age. Patients who underwent primary operative therapy had a lower aggregate in-hospital mortality rate (0% vs 3.3%), reintervention rate (2.5% vs 23.5%), length of stay (10.8 vs 20.0 days), duration of tube thoracostomy (4.4 vs 10.6 days), and duration of antibiotic therapy (12.8 vs 21.3 days), compared with patients who underwent nonoperative therapy. In 8 studies for which meta-analysis was possible, patients who received primary operative therapy were found to have a pooled relative risk of failure of 0.09, compared with those who did not. Meta-analysis could not be performed for any of the other outcome measures investigated in this review. Similar complication rates were observed for the 2 groups (5% vs 5.6%). CONCLUSIONS: These aggregate results suggest that primary operative therapy is associated with a lower in-hospital mortality rate, reintervention rate, length of stay, time with tube thoracostomy, and time of antibiotic therapy, compared with nonoperative treatment. The meta-analysis demonstrates a significantly reduced relative risk of failure among patients treated operatively.
Authors:
Jeffrey R Avansino; Bryan Goldman; Robert S Sawin; David R Flum
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Publication Detail:
Type:  Comparative Study; Journal Article; Meta-Analysis; Review    
Journal Detail:
Title:  Pediatrics     Volume:  115     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2005 Jun 
Date Detail:
Created Date:  2005-06-02     Completed Date:  2005-11-10     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1652-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, University of Washington, Box 356410, Seattle, WA 98105, USA. javansin@u.washington.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Anti-Bacterial Agents / therapeutic use
Child
Child, Preschool
Cohort Studies
Combined Modality Therapy
Empyema, Pleural / surgery,  therapy*
Female
Fibrinolytic Agents / therapeutic use
Hospital Mortality
Humans
Infant
Infant, Newborn
Length of Stay / statistics & numerical data
Male
Reoperation / statistics & numerical data
Risk
Salvage Therapy
Thoracic Surgery, Video-Assisted
Thoracostomy / utilization
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Fibrinolytic Agents
Comments/Corrections
Comment In:
Pediatrics. 2006 Apr;117(4):1462-3   [PMID:  16585357 ]
Pediatrics. 2006 Jan;117(1):261-2   [PMID:  16396897 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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