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Trends in Hospital Treatment of Empyema in Children in the United States.
- Source :
-
The Journal of pediatrics [J Pediatr] 2018 Nov; Vol. 202, pp. 245-251.e1. Date of Electronic Publication: 2018 Aug 28. - Publication Year :
- 2018
-
Abstract
- Objective: To evaluate trends in procedures used to treat children hospitalized in the US with empyema during a period that included the release of guidelines endorsing chest tube placement as an acceptable first-line alternative to video-assisted thoracoscopic surgery.<br />Study Design: We used National Inpatient Samples to describe empyema-related discharges of children ages 0-17 years during 2008-2014. We evaluated trends using inverse variance weighted linear regression and characterized treatment failure using multivariable logistic regression to identify factors associated with having more than 1 procedure.<br />Results: Empyema-related discharges declined from 3 in 100 000 children to 2 in 100 000 during 2008-2014 (P = .04, linear trend). There was no significant change in the proportion of discharges having 1 procedure (66.1% to 64.1%) or in the proportion having 2 or more procedures (22.1% to 21.6%). The proportion coded for video-assisted thoracoscopic surgery as the only procedure declined (41.4% to 36.2%; P = .03), and the proportions coded for 1 chest tube (14.6% to 20.9%; P = .04) and 2 chest tube procedures (0.9% to 3.5%; P < .01) both increased. The median length of stay for empyema-related discharges remained unchanged (9.3 days to 9.8 days; P = .053). Having more than 1 procedure was associated with continuous mechanical ventilation (adjusted OR, 2.7; 95% CI, 1.8-4.1) but not with age, sex, payer, chronic conditions, transfer admission, hospital size, or census region.<br />Conclusions: The use of video-assisted thoracoscopic surgery to treat children in the US hospitalized with empyema seems to be decreasing without associated increases in length of stay or need for additional drainage procedures.<br /> (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Subjects :
- Adolescent
Child
Child, Preschool
Cohort Studies
Databases, Factual
Disease Management
Drainage methods
Drainage statistics & numerical data
Empyema, Pleural diagnostic imaging
Empyema, Pleural epidemiology
Female
Humans
Infant
Infant, Newborn
Inpatients statistics & numerical data
Logistic Models
Male
Multivariate Analysis
Patient Discharge statistics & numerical data
Prognosis
Retrospective Studies
Severity of Illness Index
Thoracic Surgery, Video-Assisted methods
Tomography, X-Ray Computed methods
Treatment Outcome
United States
Empyema, Pleural surgery
Hospitalization statistics & numerical data
Length of Stay trends
Thoracic Surgery, Video-Assisted trends
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6833
- Volume :
- 202
- Database :
- MEDLINE
- Journal :
- The Journal of pediatrics
- Publication Type :
- Academic Journal
- Accession number :
- 30170858
- Full Text :
- https://doi.org/10.1016/j.jpeds.2018.07.004