Magnitude and treatment outcome of empyema thoracis in children admitted to St. Paul’s Hospital Millennium Medical College from 2015 to 2022

Abstract

Abstract Background: Empyema thoracis is an accumulation of pus in the pleural space. Parapneumonic effusion and Empyema thoracis are the terms used to describe complications of pneumonia. Around forty percent of bacterial pneumonia are said to be complicated by parapneumonic effusions, 10% of whom would evolve into empyema. Although, many studies were done worldwide, few in Africa; there is scarce data on the magnitude, associated factors, and treatment outcome of empyema thoracis in Ethiopia. This study assessed the clinical profile of children with empyema , the treatment practice and their outcome . Objective: - To determine the magnitude, associated factors and treatment outcome of Empyema among pediatric patients admitted to St. Paul Hospital Millennium Medical College. Methods: A retrospective chart review was conducted on children who were diagnosed with empyema thoracis that were admitted to St. Paul’s Hospital Millennium Medical College (SPHMMC) pediatrics departments over 8 year from January 2015 to December 2022.The total number of children admitted with the diagnosis of Empyema during the study period was 88. Data were collected using a structured questionnaire. Data was entered to SPSS version-27 and cleaned before analysis. Frequency and percentage descriptive statistics were used to describe the characteristics of the variable. Data analysis includes descriptive analysis, chi-square test and Binary Logistic regression was done to look for association between variables. Result: The incidence of childhood empyema in this series was 12/1000 admissions accounting for 5.3% of the cases of pneumonia, which is significantly higher compared to a previous data from Ethiopia. The associated factors that determine the outcome of empyema patients through Univariate analysis were gender, place of admission, the level of respiratory support needed, WBC count, the pleural fluid amount and initiation of anti-TB during the treatment with a P value of <0.05. However none of the variables were found to be significant with multivariable analysis. Antibiotic therapy with chest drain insertion ± intra-pleural fibrinolysis were the modality of treatment in most children with empyema thoracis ( 73% ) and surgical intervention was rarely performed. A significant number of patients ( 28%) developed complication during treatment for empyema thoracis . The most common complications were pericarditis followed by pneumothorax and necrotizing pneumonia . The majority ( 83%) recovered fully on hospital discharge while 15 were discharged with sequelae . There was no in-hospital death reported with in the 8 year study period but the outcome of 6 patients was not known . Conclusion: A significant increase in the incidence of empyema thoracis was noted in children especially in the last two years. Antibiotic therapy with chest drain insertion ± intra-pleural fibrinolysis is an effective treatment of empyema thoracis in children and surgical intervention was rarely performed. The overall outcome pediatric empyema thoracis was found to be very good in our setting . Key words: Children, Empyema, Ethiopia, outcome