Primary Operative Versus Nonoperative Therapy for Pediatric Empyema: A Meta-analysis
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. A systematic comprehensive review of the scientific literature was conducted with the...
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| Veröffentlicht in: | Pediatrics (Evanston) 2005-06, Vol.115 (6), p.1652-1659 |
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| creator | Avansino, Jeffrey R Goldman, Bryan Sawin, Robert S Flum, David R |
| description | 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.
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 ( or =1 of the outcomes of interest for both treatment groups.
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%).
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. |
| doi_str_mv | 10.1542/peds.2004-1405 |
| format | Article |
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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.
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%).
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.</description><identifier>ISSN: 0031-4005</identifier><identifier>EISSN: 1098-4275</identifier><identifier>DOI: 10.1542/peds.2004-1405</identifier><identifier>PMID: 15930229</identifier><identifier>CODEN: PEDIAU</identifier><language>eng</language><publisher>Elk Grove Village, IL: Am Acad Pediatrics</publisher><subject>Adolescent ; Anti-Bacterial Agents - therapeutic use ; Biological and medical sciences ; Bronchoscopy ; Care and treatment ; Child ; Child, Preschool ; Childhood pneumonia ; Clinical outcomes ; Cohort Studies ; Combined Modality Therapy ; Development and progression ; Empyema ; Empyema, Pleural - surgery ; Empyema, Pleural - therapy ; Endoscopy ; Female ; Fibrinolytic Agents - therapeutic use ; General aspects ; Hospital Mortality ; Humans ; Infant ; Infant, Newborn ; Inflammatory diseases ; Investigative techniques, diagnostic techniques (general aspects) ; Length of Stay - statistics & numerical data ; Male ; Medical sciences ; Meta-analysis ; Pediatrics ; Pneumonia in children ; Reoperation - statistics & numerical data ; Risk ; Risk factors ; Salvage Therapy ; Surgery ; Thoracic Surgery, Video-Assisted ; Thoracostomy - utilization ; Treatment Outcome</subject><ispartof>Pediatrics (Evanston), 2005-06, Vol.115 (6), p.1652-1659</ispartof><rights>2005 INIST-CNRS</rights><rights>COPYRIGHT 2005 American Academy of Pediatrics</rights><rights>COPYRIGHT 2005 American Academy of Pediatrics</rights><rights>Copyright American Academy of Pediatrics Jun 2005</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c539t-fdb109a58665ebdc06d5d696f41fa5da3acb31930346145e97d3391757fdfe4a3</citedby><cites>FETCH-LOGICAL-c539t-fdb109a58665ebdc06d5d696f41fa5da3acb31930346145e97d3391757fdfe4a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,778,782,27907,27908</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16808043$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15930229$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Avansino, Jeffrey R</creatorcontrib><creatorcontrib>Goldman, Bryan</creatorcontrib><creatorcontrib>Sawin, Robert S</creatorcontrib><creatorcontrib>Flum, David R</creatorcontrib><title>Primary Operative Versus Nonoperative Therapy for Pediatric Empyema: A Meta-analysis</title><title>Pediatrics (Evanston)</title><addtitle>Pediatrics</addtitle><description>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.
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.
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%).
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.</description><subject>Adolescent</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Bronchoscopy</subject><subject>Care and treatment</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Childhood pneumonia</subject><subject>Clinical outcomes</subject><subject>Cohort Studies</subject><subject>Combined Modality Therapy</subject><subject>Development and progression</subject><subject>Empyema</subject><subject>Empyema, Pleural - surgery</subject><subject>Empyema, Pleural - therapy</subject><subject>Endoscopy</subject><subject>Female</subject><subject>Fibrinolytic Agents - therapeutic use</subject><subject>General aspects</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Inflammatory diseases</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Meta-analysis</subject><subject>Pediatrics</subject><subject>Pneumonia in children</subject><subject>Reoperation - statistics & numerical data</subject><subject>Risk</subject><subject>Risk factors</subject><subject>Salvage Therapy</subject><subject>Surgery</subject><subject>Thoracic Surgery, Video-Assisted</subject><subject>Thoracostomy - utilization</subject><subject>Treatment Outcome</subject><issn>0031-4005</issn><issn>1098-4275</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNptkk2P0zAQhiMEYsvClSOKkEDikK6_k3CrqmVBKnQPhavl2uPUq3ytnQD99zhKxbKo8sGj0TOed8ZvkrzGaIk5I1c9mLAkCLEMM8SfJAuMyiJjJOdPkwVCFGcMIX6RvAjhDkWM5-R5coF5SREh5SLZ3XrXKH9Mtz14NbifkP4AH8aQfuva7m9ud4hRf0xt59NbME4N3un0uumP0KiP6Sr9CoPKVKvqY3DhZfLMqjrAq9N9mXz_dL1bf84225sv69Um05yWQ2bNPqpVvBCCw95oJAw3ohSWYau4UVTpPcVRKWUCMw5lbigtcc5zaywwRS-T9_O7ve_uRwiDbFzQUNeqhW4MUuRFGacsIvj2P_CuG31UGyQhBeWsEDhC2QxVqgbpWtsNXukK2jh63bVgXUyvMKWoQIKgyC_P8PEYaJw-W_DhUUFkBvg9VGoMQRY3m8dsdo7VXV1DBTKucb09K0b7LgQPVvbzx0qM5OQUOTlFTk6Rk1NiwZvTSsZ9A-YBP1kjAu9OgApa1darVrvwwIkitmY0clczd3DV4ZfzMHWaDRL-CTHmUsQqTugfQ9jTuA</recordid><startdate>20050601</startdate><enddate>20050601</enddate><creator>Avansino, Jeffrey R</creator><creator>Goldman, Bryan</creator><creator>Sawin, Robert S</creator><creator>Flum, David R</creator><general>Am Acad Pediatrics</general><general>American Academy of Pediatrics</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>8GL</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>20050601</creationdate><title>Primary Operative Versus Nonoperative Therapy for Pediatric Empyema: A Meta-analysis</title><author>Avansino, Jeffrey R ; Goldman, Bryan ; Sawin, Robert S ; Flum, David R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c539t-fdb109a58665ebdc06d5d696f41fa5da3acb31930346145e97d3391757fdfe4a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Adolescent</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Bronchoscopy</topic><topic>Care and treatment</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Childhood pneumonia</topic><topic>Clinical outcomes</topic><topic>Cohort Studies</topic><topic>Combined Modality Therapy</topic><topic>Development and progression</topic><topic>Empyema</topic><topic>Empyema, Pleural - surgery</topic><topic>Empyema, Pleural - therapy</topic><topic>Endoscopy</topic><topic>Female</topic><topic>Fibrinolytic Agents - therapeutic use</topic><topic>General aspects</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Inflammatory diseases</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Meta-analysis</topic><topic>Pediatrics</topic><topic>Pneumonia in children</topic><topic>Reoperation - statistics & numerical data</topic><topic>Risk</topic><topic>Risk factors</topic><topic>Salvage Therapy</topic><topic>Surgery</topic><topic>Thoracic Surgery, Video-Assisted</topic><topic>Thoracostomy - utilization</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Avansino, Jeffrey R</creatorcontrib><creatorcontrib>Goldman, Bryan</creatorcontrib><creatorcontrib>Sawin, Robert S</creatorcontrib><creatorcontrib>Flum, David R</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: High School</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatrics (Evanston)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Avansino, Jeffrey R</au><au>Goldman, Bryan</au><au>Sawin, Robert S</au><au>Flum, David R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Primary Operative Versus Nonoperative Therapy for Pediatric Empyema: A Meta-analysis</atitle><jtitle>Pediatrics (Evanston)</jtitle><addtitle>Pediatrics</addtitle><date>2005-06-01</date><risdate>2005</risdate><volume>115</volume><issue>6</issue><spage>1652</spage><epage>1659</epage><pages>1652-1659</pages><issn>0031-4005</issn><eissn>1098-4275</eissn><coden>PEDIAU</coden><abstract>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.
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.
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%).
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.</abstract><cop>Elk Grove Village, IL</cop><pub>Am Acad Pediatrics</pub><pmid>15930229</pmid><doi>10.1542/peds.2004-1405</doi><tpages>8</tpages></addata></record> |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Adolescent Anti-Bacterial Agents - therapeutic use Biological and medical sciences Bronchoscopy Care and treatment Child Child, Preschool Childhood pneumonia Clinical outcomes Cohort Studies Combined Modality Therapy Development and progression Empyema Empyema, Pleural - surgery Empyema, Pleural - therapy Endoscopy Female Fibrinolytic Agents - therapeutic use General aspects Hospital Mortality Humans Infant Infant, Newborn Inflammatory diseases Investigative techniques, diagnostic techniques (general aspects) Length of Stay - statistics & numerical data Male Medical sciences Meta-analysis Pediatrics Pneumonia in children Reoperation - statistics & numerical data Risk Risk factors Salvage Therapy Surgery Thoracic Surgery, Video-Assisted Thoracostomy - utilization Treatment Outcome |
| title | Primary Operative Versus Nonoperative Therapy for Pediatric Empyema: A Meta-analysis |
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