Over the past 10 years, a complication of pneumonia called pleural empyema which is excess pus around the lungs, has doubled and even tripled in incidence. Some children affected by the disease are admitted to hospital and have chest drains to clean out pus that has collected around the lungs.
The increase in complicated pneumonia is likely owing to antibiotic resistance and higher prevalence of non-vaccine serotypes, in other words, the types of the bug that are not destroyed by the pneumococcus vaccine.
A study led by The Hospital for Sick Children (SickKids) explored the long-term outcomes for patients with complicated pneumonia, some who needed chest drains and others who did not. They found that virtually all of the patients had normal outcomes. The study is published in the September 3 advance online edition of Archives of Pediatric Adolescent Medicine.
SickKids is seeing increased numbers of complicated pneumonia, approaching 50 cases a year. “There is a lot of debate about how aggressively we should be treating these kids,” says Dr. Eyal Cohen, lead author of the study and Staff Physician in the Division of Paediatric Medicine at SickKids. “In some paediatric hospitals children are sent to the operating room to have their chests cleaned out, in the belief that this could prevent them from developing any long-term lung problems. There is evidence that these types of procedures have good short-term outcomes, in that they help kids get better faster, but up until now we didn’t really know what happened to these kids in the long term.”
SickKids has been relatively conservative in its treatment of complicated pneumonia, using image-guided therapy and minimally invasive techniques to insert a chest drain when necessary.
The study followed 82 patients with complicated pneumonia, some who had chest drains and some who didn’t, during follow-up at one month, six months and one year. At the end of the follow-up period, virtually all of the patients had normal chest X-rays, normal lung function and reported normal quality of life.
“This is good news for patients, families and clinicians because basically no matter how sick these kids are when they come in, generally they all have completely normal outcomes,” says Cohen, who is also Project Investigator in Child Health Evaluative Sciences at SickKids and Associate Professor in the Department of Paediatrics at the University of Toronto. “We are not advising that children shouldn’t ever be treated with chest drains, as we know the short and long term outcomes are both positive, but rather that this information can help decision making for clinicians and families when balancing the risks and benefits of different strategies for treating complicated pneumonia.”
The study was supported by the Dean’s New Faculty Grant at the University of Toronto, the Paediatric Consultants Creative Professional Activity Grant at SickKids and by a team grant for the Paediatric Outcomes Research Team (PORT) and SickKids Foundation.
About The Hospital for Sick Children
The Hospital for Sick Children (SickKids) is recognized as one of the world’s foremost paediatric health-care institutions and is Canada’s leading centre dedicated to advancing children’s health through the integration of patient care, research and education. Founded in 1875 and affiliated with the University of Toronto, SickKids is one of Canada’s most research-intensive hospitals and has generated discoveries that have helped children globally. Its mission is to provide the best in complex and specialized family-centred care; pioneer scientific and clinical advancements; share expertise; foster an academic environment that nurtures health-care professionals; and champion an accessible, comprehensive and sustainable child health system. SickKids is proud of its vision of Healthier Children. A Better World.™ For more information, please visit www.sickkids.ca.
About SickKids Centre for Research and Learning
The SickKids Centre for Research and Learning will bring together researchers from different scientific disciplines and a variety of clinical perspectives, to accelerate discoveries, new knowledge and their application to child health — a different concept from traditional research building designs. The facility will physically connect SickKids science, discovery and learning activities to its clinical operations. Designed by award-winning architects Diamond + Schmitt Inc. and HDR Inc. with a goal to achieve LEED® Gold Certification for sustainable design, the Centre will create an architectural landmark as the eastern gateway to Toronto’s Discovery District. The SickKids Centre for Research and Learning is funded by a grant from the Canada Foundation for Innovation, the Government of Ontario, philanthropist Peter Gilgan and community support for the ongoing fundraising campaign. For more information, please visit www.sickkidsfoundation.com/bepartofit.
For more information, please contact:
The Hospital for Sick Children
The Hospital for Sick Children
Phone: 416-813-7654 ext. 1436