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Poster - 55
Key Determinants Guiding Treatment Algorithms in Pediatric Empyema: Five Years of Single-Center Experience
İlayda Ser, Meltem Kaba, Mesut Demir, Nihat Sever, zeynab Mirhashimli, Abdullah Yıldız, Çetin Ali Karadağ
Health Sciences University, Şişli Hamidiye Etfal SUAM, Pediatric Surgery Departmant, Istanbul
Objective:This retrospective study evaluated pediatric empyema outcomes by stage and sought predictors for surgical decortication, particularly after intrapleural tissue plasminogen activator(tPA) therapy.
Materials and Methods:We retrospectively analyzed 96 cases between 2020-2025.
Results:Cases were classified as StageI (n=34), StageII (n=48), and StageIII (n=14). Mean age was 8.7 years, and 33% were female.StageI had the shortest hospital stay (mean 13.5 days) versus StageII (25.5 days) and StageIII (29.5 days; p<0.001). StageI was predominantly managed non-surgically: 76% improved with thoracentesis and iv antibiotics (mean duration 11.6 days).Tube thoracostomy was performed in 42 cases (StageI: 8; StageII: 34). In StageII, 59% (20/34) received intrapleural tPA, but 30% of those required video-assisted thoracoscopic surgery (VATS).Overall, tPA was given to 26 patients (20 StageII; 6 StageIII), and 46% (12) required decortication (83% VATS, 17% open); mean time to tPA initiation and subsequent surgery were 10.2 and 19.5 days, respectively. Hospital stay averaged 22 days with successful tPA alone versus 35.5 days when tPA failed and surgery was needed (p=0.002). Surgical decortication via VATS was performed in 32 patients (StageII: 20; StageIII: 12), with a mean stay of 29 days; early VATS within 7 days (n=6) yielded much shorter stays (13.6 days, p<0.001). All four patients requiring open thoracotomy were Stage III with bilateral involvement; their surgery occurred at 17 days and mean stay was 38 days.
Conclusion:Despite tPA, 46% of patients ultimately required surgery. StageIII, prolonged symptom duration, and necrotizing pneumonia predicted the need for decortication. Early surgical intervention (within 7 days) reduced hospital stay. These findings highlight the need for better algorithms to predict fibrinolytic therapy failure and for prompt surgery in high-risk patients to reduce morbidity.