Primary Early Thoracoscopy and Reduction in Length of Hospital Stay and Additional Procedures Among Children With Complicated Pneumonia

Shah, Samir S.; DiCristina, Cara M.; Bell, Louis M.; Have, Tom Ten; Metlay, Joshua P.

doi:10.1001/archpedi.162.7.675

Cited by 60 publications

(35 citation statements)

References 40 publications

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“…The authors of these studies concluded that, despite the small sample sizes, the lack of significant differences indicates that the interventions are equally effective. These findings contradict the findings of previous retrospective studies, but those likely were influenced by case selection bias [21,22].…”

contrasting

confidence: 97%

Establishing Equipoise: National Survey of the Treatment of Pediatric Para-Pneumonic Effusion and Empyema

Richards

McAteer

Edwards

et al. 2017

Surgical Infections

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Background: Despite six randomized trials of various treatments for pediatric para-pneumonic effusion (PPE), management approaches differ. The purpose of this study was to gain insight into opinions on PPE treatment with the goal of designing a definitive trial to generate consensus intervention guidelines. Methods: To evaluate physician opinions regarding PPE management, we developed a survey based on input from a nationwide, multi-disciplinary advisory group that established content validity. The survey was disseminated broadly to six pediatric medicine and interventional radiology groups. Descriptive and w 2 statistics were calculated. Results: There were 741 respondents (response rate 13.1%), of whom 52.2% were surgeons, 15.2% hospitalists, 14.2% pulmonologists, 12.4% intensivists, and 6.0% interventional radiologists. Nearly all respondents (97.3%) reported caring primarily for pediatric patients. Eighty percent reported no written institutional treatment guidelines. Nearly all (90.3%) agreed that patients require antibiotics, but there was disagreement regarding their duration. Respondents also were split as to how often PPE required drainage. There were multiple absolute indications for drainage, including mediastinal shift on chest radiograph (67.2%) and loculations on imaging (47.7%). There were substantial differences in the preferred first-line methods of drainage based on the treating physician's specialty, with surgeons preferring tube thoracostomy and a fibrinolytic agent (42.0%) or videoassisted thoracoscopic surgery (41.6%), whereas interventional radiologists preferred either a tube thoracostomy (46.4%) or a tube thoracostomy with a fibrinolytic agent (39.3%) (p < 0.001). A large majority (75.3%) believed that the published evidence does not identify the optimal intervention. Conclusions: There is a lack of consensus regarding the optimal treatment of PPE. Respondents believed the published evidence is inconclusive and were willing to participate in a prospective trial. These findings will help inform the design of a randomized, pragmatic clinical trial to optimize PPE management.

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contrasting

confidence: 97%

Establishing Equipoise: National Survey of the Treatment of Pediatric Para-Pneumonic Effusion and Empyema

Richards

McAteer

Edwards

et al. 2017

Surgical Infections

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“…Many authors have suggested that thoracoscopy is more advantageous as the initial treatment than tube thoracostomy alone [17][18][19]. Shah's multicenter study supports the early use of thoracoscopy, pointing to shorter hospital stays and fewer instances of further surgery [20]. Indeed, the separation and washing out of the septa allows for better visibility inside the thoracic cavity and more efficient expansion of the affected lung [21].…”

Section: Dctd -Duration Of Chest Tube Drainage; Los -Length Of Staymentioning

confidence: 99%

THORACIC SURGERY Which technique is the best for the surgical management of empyema thoracis in children?

Tander¹,

Bıçakçı²,

Günaydın³

et al. 2013

kitp

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StreszczenieWstęp: Ocenione zostały różnice między jednoportowymi (single-port techniques -SPT) oraz dwuportowymi (two-port techniques -TPT) metodami usuwania ropniaka opłucnej u dzieci. Materiał i metody: Od 51 pacjentów z ropniakiem opłucnej (33 mężczyzn, 18 kobiet) pobrano następujące dane: wiek, płeć, wyniki badań przedmiotowych, typ torakoskopii, długość pobytu w szpitalu (lenght of stay -LOS) oraz czas trwania drenażu klatki piersiowej (duration of chest tube drainage -DCTD). Metodę SPT zastosowano u 14 pacjentów, a TPT u 37. W przypadku SPT jako narzędzie tnące używany jest sam teleskop. Podczas procesu oczyszczania do organizmu nie wprowadza się innych narzędzi. W przypadku TPT pierwszy otwór używany jest do wprowadzenia teleskopu, a drugi przeznaczony jest dla narzędzia chirurgicznego. Przez jeden z otworów wprowadzany jest następnie dren. Wyniki: U 24 pacjentów ropniak znajdował się w prawej czę-ści klatki piersiowej, natomiast u 25 pacjentów umiejscowiony był po lewej stronie. U dwóch pacjentów klatka piersiowa była obustronnie zajęta. W grupie SPT dren był usuwany z klatki piersiowej po średnio 13 dniach, natomiast w grupie TPT po średnio 11 dniach. Średni LOS wynosił odpowiednio 20 i 13 dni dla grup SPT i TPT. U 4 pacjentów z grupy SPT i 2 pacjentów z grupy TPT wystąpiły samoistnie ustępujące przetoki oskrzelowo-opłucnowe. Nie stwierdzono istotnych różnic między zastosowanymi metodami w zależności od wieku, płci, miejsca wystąpienia ropniaka, gorączki i pojawienia się przetoki oskrzelowo-opłucnowej. Zarówno LOS, jak i DCTD były krótsze w przypadku pacjentów z grupy TPT, jednakże różnica ta nie była istotna statystycznie. Wnioski: Mimo że różnice nie są wielkie, metoda TPT używana do usuwania zaawansowanego ropniaka u dzieci wydaje się bardziej efektywna pod względem LOS, DCTD oraz ryzyka wystąpienia przetoki oskrzelowo-opłucnowej. Słowa kluczowe: ropniak, metoda jednoportowa, metoda dwuportowa. Kardiochirurgia i Torakochirurgia Polska 2013; 10 (2) 130 THORACIC SURGERY AbstractIntroduction: The differences between single-port (SPT) and two-port techniques (TPT) for the debridement of advanced thoracic empyema in children were evaluated. Material and methods: Age, gender, physical findings, type of thoracoscopic intervention, the length of stay (LOS) and the duration of chest tube drainage (DCTD) were reviewed in 51 patients with thoracic empyema (33 M, 18 F). The SPT was used in 14 patients, while the TPT was used in 37 patients. In the SPT, the telescope itself was used as a dissecting tool. No other instrument was inserted during the debridement. In the TPT, the first port is made for the telescope and the second port for the surgical instrument. A chest tube is inserted through the port site. Results: The empyema was located in the right hemithorax in 24 patients and in the left hemithorax in 25 patients. Two patients suffered from bilateral involvement. The chest tube was removed after a median of 13 days in the SPT and 11 days in the TPT patients. The LOS was a median of 20 days and 13 days in p...

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“…A series of studies began to emerge analyzing data from large administrative datasets that described the variation in hospital care (but lack clinical results and clinical outcomes outside of the hospital setting), such as the Pediatric Health Information Systems (PHIS) database operated by the Children's Hospital Association (formerly known as the Child Health Corporation of America). [9][10][11][12][13] Pediatric hospital medicine fellowships began to appear, 14 and over time, a cohort of hospitalist investigators with sufficient independence to mentor others arose.…”

Section: Hospital Medicine Research: Growth and Developmentmentioning

confidence: 99%

Development of the pediatric research in inpatient settings (PRIS) network: Lessons learned

Srivastava

Landrigan

2012

Journal of Hospital Medicine

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Primary Early Thoracoscopy and Reduction in Length of Hospital Stay and Additional Procedures Among Children With Complicated Pneumonia

Abstract: Our large retrospective multicenter study demonstrates that, compared with primary chest tube placement, primary VATS is associated with shorter LOS and fewer additional procedural interventions.

Cited by 60 publications

References 40 publications

Establishing Equipoise: National Survey of the Treatment of Pediatric Para-Pneumonic Effusion and Empyema

Establishing Equipoise: National Survey of the Treatment of Pediatric Para-Pneumonic Effusion and Empyema

THORACIC SURGERY Which technique is the best for the surgical management of empyema thoracis in children?

Development of the pediatric research in inpatient settings (PRIS) network: Lessons learned

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