澳大利亚北昆士兰州地区小儿胸腔脓胸(pTE)的发病率很高。我们描述了汤斯维尔大学医院的脓胸管理,该医院是这些儿童的区域转诊中心。还讨论了新制定的机构准则的影响。
这项回顾性审计包括2007年1月1日至2018年12月31日期间接受脓胸治疗的16岁以下儿童。人口统计学和管理相关变量与结果相关。2017年初引入了当地指南,患者预后特征在之前,并对该指南的介绍进行了比较。
有153名患有pTE的儿童(在引入当地指南之前为123名,之后为30名)。非手术治疗与较高的治疗失败率相关。中位住院时间(LOS)为11.8(IQR9.3-16)天。住院时间较长与年龄较小有关(r2-0.16,P=0.04),原住民和/或托雷斯海峡(ATSI)血统(13.8vs.10.5天,P=0.002)和伴随的呼吸道病毒感染(14.4vs.10.9天,P=0.003)。引入当地指南与经验性胸部CT扫描的使用显着减少有关(前与前的54.4%6.7%之后,P<0.001)和静脉注射抗生素的持续时间(前14天vs.10天后,P=0.02)。医院LOS没有显著变化(前12.1天和后11.7天,P=0.8)。
年龄较小,合并的病毒性呼吸道感染和ATSI血统被确定为LOS增加的潜在危险因素.通过机构指南后的医院LOS没有变化。然而,这样的指南可以确定有不良病程风险的人群,并避免不必要的抗生素治疗和辐射暴露。
The North Queensland region of Australia has a high incidence of pediatric thoracic empyema (pTE). We describe the management of empyema at the Townsville University Hospital which is the regional referral center for these children. The impact of a newly developed institutional
guideline is also discussed.
This retrospective audit included children under the age of 16 years treated for empyema between 1 Jan 2007 and 31 December 2018. Demographic and management-related variables were correlated to outcomes. A local
guideline was introduced at the beginning of 2017 and patient outcomes characteristics pre, and post introduction of this
guideline are compared.
There were 153 children with pTE (123 before and 30 after the introduction of a local
guideline). Nonsurgical management was associated with a higher treatment failure rate. Median length of stay (LOS) was 11.8 (IQR 9.3-16) days. Longer hospital LOS was associated with younger age (r2 -0.16, P = 0.04), Aboriginal and/or Torres Strait (ATSI) ancestry (13.8 vs. 10.5 days, P = 0.002) and concomitant respiratory viral infections (14.4 vs. 10.9 days, P = 0.003). The introduction of local guideline was associated with significant decrease in the use of empirical chest CT scans (54.4% before vs. 6.7% after, P < 0.001) and duration of intravenous antibiotics (14 days before vs. 10 days after, P = 0.02). There was no significant change in the hospital LOS (12.1 days pre and 11.7 post, P = 0.8).
Younger age, concomitant viral respiratory infections and ATSI ancestry were identified as potential risk factors for increase LOS. Hospital LOS following the adoption of an institutional
guideline was unchanged. However, such a guideline may identify populations at risk for an unfavorable course and avoid unnecessary antibiotic treatment and radiation exposure.