Purpose: Empyema has a high prevalence in children, with a mortality rate of 10% - 27%. Accurate staging of the exudative, fibrinopurulent, and organizing phases is crucial for effective treatment. This study aimed to improve the preoperative staging of empyema to enhance treatment outcomes. Methods: Pediatric patients with empyema who were initially treated with tube thoracostomy between January 2014 and December 2023 were retrospectively analyzed. The primary outcome was the comparison of drainage volume on the first day (DV1st) between the tube thoracostomy and surgical conversion groups. The secondary outcome was the comparison of the DV1st-to-body weight ratio (DV1st/BW) between the two groups. Results: A total of 31 patients were treated, with 15 undergoing initial tube thoracostomy. The tube thoracostomy group had a significantly higher median DV1st (155.5 mL) than that of the surgical conversion group (20.0 mL, p = 0.04). The receiver operating characteristic curve analysis identified DV1st and DV1st/BW cutoffs of 20 mL and 6.90 (area under the curve = 0.84 for both), indicating that higher initial drainage volumes may predict successful non-surgical treatment. Conclusion: DV1st and DV1st/BW may be effective indicators for determining the need for surgical intervention, potentially enabling earlier and more accurate treatment decisions.
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