PEDIATRIC EMPYEMA THORACIS: A TWO-YEAR PROSPECTIVE OBSERVATIONAL STUDY OF CLINICAL PROFILE, MICROBIOLOGICAL SPECTRUM, AND SURGICAL OUTCOMES AT A TERTIARY CARE CENTRE IN SOUTH INDIA

Background: Pediatric empyema thoracis is a serious complication of pneumonia that may result in prolonged hospitalization and require invasive pleural interventions. Ultrasonography (USG) provides a practical, radiation-free method for staging pleural disease and may facilitate stage-directed management. This study evaluated the clinical profile, microbiological spectrum, and outcomes of a structured USG-based treatment protocol for pediatric empyema thoracis at a tertiary care centre in South India. Methods: A prospective observational study was conducted in the Department of General Surgery, Al-Ameen Medical College Hospital, Vijayapura, Karnataka, over a two-year period. Forty-five children below 18 years of age with USG-confirmed empyema thoracis were evaluated. Patients were categorized into three USG stages: Stage 1, free-flowing exudative effusion; Stage 2, fibrinopurulent or loculated disease; and Stage 3, organizing disease with pleural peel and/or lung entrapment. Stage-directed treatment consisted of intercostal drainage (ICD) for Stage 1, ICD with intrapleural streptokinase (IPSK) for Stage 2, and video-assisted thoracoscopic surgery (VATS) or open decortication for Stage 3 disease. Clinical, microbiological, treatment, complication, hospitalization, and three-month radiological outcomes were assessed.