Strachan Roxanne, Jaffé Adam
Department of Respiratory Medicine, Sydney Children's Hospital, High Street, Randwick, New South Wales 2031, Australia.
J Paediatr Child Health. 2009 Jul-Aug;45(7-8):431-6. doi: 10.1111/j.1440-1754.2009.01533.x.
To investigate the change in incidence of childhood empyema and pneumonia in Australia, and ascertain the management trends in all hospitals caring for children with empyema.
The incidences of empyema and pneumonia were calculated for each year between 1993/1994 and 2004/2005 using retrospective primary diagnostic coding from ICD-9 and 10 comprising the Australian National Hospital Morbidity Database for five age groups in patients less than 20 years of age. Hospitals with allocated paediatric beds were surveyed on referral pattern and treatment preferences.
In this study, 145 562 patients with pneumonia were admitted with a mean (range) incidence of 2306 (1846-2652) per million. The trend towards an overall increase was not statistically significant. Only the 1-4 years old age group demonstrated a significant increase (P < 0.01, r2 = 0.61). A total of 469 cases of empyema were identified with a mean incidence of 7.35 (4-10.2) per million. There was an overall increase in incidence (P < 0.05, r2 = 0.51) reflecting an increase in the 1- to 4-year-olds (P < 0.005, r2 = 0.60) and 15- to 19-year-olds (P < 0.05, r2 = 0.37). The overall percentage of empyema as a proportion of pneumonia increased from 0.27 to 0.70% (0.48% (0.27-0.70%), P < 0.05, r2 = 0.38). The survey response rate was 75%. Ninety-nine of 121 (82%) hospitals referred children with empyema to a more appropriate centre with wide variations in treatments provided.
The rise in incidence of empyema reflects that seen in other countries. Furthermore, there are diverse management practices suggesting a clear need for national guidelines.
调查澳大利亚儿童脓胸和肺炎发病率的变化，并确定所有诊治儿童脓胸医院的治疗趋势。
利用1993/1994年至2004/2005年期间澳大利亚国家医院发病率数据库中ICD - 9和ICD - 10的回顾性初级诊断编码，计算20岁以下五个年龄组的脓胸和肺炎发病率。对设有儿科床位的医院进行转诊模式和治疗偏好调查。
本研究中，145562例肺炎患者入院，平均发病率为每百万2306例（1846 - 2652例）。总体上升趋势无统计学意义。仅1 - 4岁年龄组有显著上升（P < 0.01，r2 = 0.61）。共确诊469例脓胸，平均发病率为每百万7.35例（4 - 10.2例）。发病率总体上升（P < 0.05，r2 = 0.51），反映出1 - 4岁儿童（P < 0.005，r2 = 0.60）和15 - 19岁青少年（P < 0.05，r2 = 0.37）发病率上升。脓胸占肺炎的总体比例从0.27%增至0.70%（0.48%（0.27 - 0.70%），P < 0.05，r2 = 0.38）。调查回复率为75%。121家医院中有99家（82%）将脓胸患儿转诊至更合适的中心，所提供的治疗差异很大。
脓胸发病率上升与其他国家情况一致。此外，治疗方法多样，表明显然需要国家指南。
