Evolution of intrapleural bleeding in pediatric empyema management : a 10-year single-center study assessing associated risk factors

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BACKGROUND: Pediatric empyema requires hospitalization, broad-spectrum antibiotics, and thoracic drainage with intrapleural fibrinolytics (IPF). Intrapleural bleeding is the main cause of early IPF cessation. While adult studies identified bleeding risk factors, pediatric data are limited, and adult findings may not apply due to different comorbidities. This study describes intrapleural bleeding rates in pediatric empyema over 10 years and explores associated risk factors. METHODS: We retrospectively analyzed clinical, radiological, and microbiological data of patients <18 years admitted to CHU Sainte-Justine (2014–2024) for empyema, identified via ICD-10 codes and clinical lists. Intrapleural bleeding was documented from treating physicians’ notes. Trends and potential risk factors were assessed. RESULTS: Among 260 patients, 238 (91.5%) had chest drainage (median duration: 6 days). IPF was used in 195 (82%) cases, with a median of 3 doses. Bleeding occurred in 23 (9.6%) cases, but no transfusions were required. Bleeding rates increased over time (p<0.01), with no identified clinical, radiological, or biological risk factors. However, an association was found with rhinovirus/enterovirus co-infection (p<0.01). CONCLUSIONS: Intrapleural bleeding rates increased over 10 years, with no clear risk factors except for a possible association with rhinovirus/enterovirus. This descriptive study highlights the need for further research to confirm this finding and improve risk assessment.

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