Post-traumatic empyema: Aetiology, surgery and outcome in 125 consecutive patients

James V. O'Connor, Albert Chi, Manjari Joshi, Joe Dubose, Thomas M. Scalea

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Introduction: Empyema remains a potentially serious condition with multiple etiologies including post-pneumonic, post-resection, and post-traumatic. There are few studies describing the latter. We reviewed our experience at a high volume trauma centre in injured patients with empyema, examining pre-operative status, surgical procedures, pathogens and outcome. Methods: Retrospective trauma registry review, from 9/01 to 4/10. Empyema was defined as culture positive pleural fluid or purulence at operation. Data collected included demographics, injury mechanism, thoracic injuries, organ dysfunction, pathogens isolated, surgical procedures, outcomes and follow up. Results: One hundred twenty-five consecutive patients with empyema were identified. Average injury severity score and age were 27.3 and 37.2 years respectively; 89.6% were male, 63.2% sustained blunt chest trauma. Time from injury to diagnosis averaged 12.1 days. All underwent decortication; 80% by thoracotomy, the remainder thoracoscopically. At operation over half were mechanically ventilated and 13.6% required vasoactive infusions. Monomicrobial cultures with Gram positive cocci predominating were obtained in 44%, 48% had polymicrobial cultures and 18.4% had a ruptured lung abscess. There were five deaths (4%); two occurring after a ruptured lung abscess. Recurrent empyema occurred in 6.4%, all successfully treated by re-operation or catheter drainage. Intensive care and hospital stays were 18.1 and 30.6 days respectively. All survivors achieved resolution of empyema. Conclusions: Trauma patients with empyema represent a subset of severely injured critically ill patients with diverse pathogens and polymicrobial flora. Appropriate surgical management and specific antibiotic therapy yields excellent results with acceptable risk. A ruptured lung abscess may be the aetiology of the post-traumatic empyema in a subset of patients and may represent an increased operative risk.

Original languageEnglish (US)
Pages (from-to)1153-1158
Number of pages6
JournalInjury
Volume44
Issue number9
DOIs
StatePublished - Sep 1 2013
Externally publishedYes

Fingerprint

Empyema
Lung Abscess
Wounds and Injuries
Gram-Positive Cocci
Thoracic Injuries
Injury Severity Score
Trauma Centers
Operative Surgical Procedures
Thoracotomy
Critical Care
Critical Illness
Survivors
Registries
Drainage
Length of Stay
Thorax
Catheters
Demography
Anti-Bacterial Agents
Lung

Keywords

  • Empyema
  • Pleural Space
  • Trauma

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine

Cite this

Post-traumatic empyema : Aetiology, surgery and outcome in 125 consecutive patients. / O'Connor, James V.; Chi, Albert; Joshi, Manjari; Dubose, Joe; Scalea, Thomas M.

In: Injury, Vol. 44, No. 9, 01.09.2013, p. 1153-1158.

Research output: Contribution to journalArticle

O'Connor, James V. ; Chi, Albert ; Joshi, Manjari ; Dubose, Joe ; Scalea, Thomas M. / Post-traumatic empyema : Aetiology, surgery and outcome in 125 consecutive patients. In: Injury. 2013 ; Vol. 44, No. 9. pp. 1153-1158.
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