Therapy of parapneumonic empyema in children: a protocol for a scoping review of the literature

Danilo Buonsenso; Francesca Cusenza; Lucrezia Passadore; Francesca Bonanno; Carolina Calanca; Sonia Rasmi; Francesco Mariani; Susanna Maria Roberta Esposito

doi:10.12688/f1000research.135295.2

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Study Protocol

Revised

Therapy of parapneumonic empyema in children: a protocol for a scoping review of the literature

[version 2; peer review: 2 approved]

Danilo Buonsenso ¹, Francesca Cusenza², Lucrezia Passadore², [...] Francesca Bonanno², Carolina Calanca², Sonia Rasmi², Francesco Mariani¹, Susanna Maria Roberta Esposito²

Danilo Buonsenso ¹, Francesca Cusenza², [...] Lucrezia Passadore², Francesca Bonanno², Carolina Calanca², Sonia Rasmi², Francesco Mariani¹, Susanna Maria Roberta Esposito²

PUBLISHED 03 Jun 2024

Author details Author details

¹ Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy, Rome, Italy
² ] Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy, parma, Italy

Danilo Buonsenso
Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Francesca Cusenza
Roles: Data Curation, Formal Analysis, Investigation

Lucrezia Passadore
Roles: Data Curation, Formal Analysis, Investigation

Francesca Bonanno
Roles: Data Curation, Formal Analysis, Investigation

Carolina Calanca
Roles: Data Curation, Formal Analysis, Investigation

Sonia Rasmi
Roles: Data Curation, Formal Analysis, Investigation

Francesco Mariani
Roles: Conceptualization, Data Curation, Funding Acquisition, Investigation

Susanna Maria Roberta Esposito
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Background

Empyema (the presence of pus in the pleural space) is a severe complication of community-acquired pneumonia and significant cause of morbidity, but, fortunately, not mortality in children. Between 0.6 and 2% of pneumonias are complicated by empyema and the three main pathogens involved are Streptococcus pneumoniae, Staphylococcus aureus and group A Streptococcus 1,2,3,4. Optimal management in children, especially the choice of antibiotics, method of administration and duration of therapy, pleural dranage or surgery, are still a matter of debate and currently, lack of strong specific recommendations. This paper displays the study protocol for a scoping review that aims to summarize the available literature on the microbiological epidemiology, the medical and surgical treatment options, and the outcomes of pleural empyema in pediatric population.

Methods

Comprehensive research combining the terms pediatric (children aged 0 to 18 years) and pleural empyema will be performed on PubMed and SCOPUS to identify all eligible studies. At first, two reviewers will screen the abstract and then their full text to determine the articles that meet the inclusion criteria. This work will be carried out independently, everyone on a different Excel spreadsheet and each researcher will be blinded to the decision of the other researcher. When the process is completed, in case of discordance, any disagreement will be identified and resolved through discussion or with help of a third author.

Dissemination

The findings of this review will be published in a peer-reviewed journal.

Keywords

Parapneumonic empyema; complicated pneumonia; children

Corresponding author: Danilo Buonsenso

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2024 Buonsenso D et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Buonsenso D, Cusenza F, Passadore L et al. Therapy of parapneumonic empyema in children: a protocol for a scoping review of the literature [version 2; peer review: 2 approved]. F1000Research 2024, 12:1527 (https://doi.org/10.12688/f1000research.135295.2) First published: 28 Nov 2023, 12:1527 (https://doi.org/10.12688/f1000research.135295.1) Latest published: 03 Jun 2024, 12:1527 (https://doi.org/10.12688/f1000research.135295.2)

Revised Amendments from Version 1

We have performed the requested changes.
In particular we have:
- clarified further some inclusion and exclusion criteria
- clarified analyses according to microbiological results
- expanded outcomes and literature research
- improved grammar structure as suggested by reviewer 1

See the authors' detailed response to the review by King-Pui Florence Chan
See the authors' detailed response to the review by Catherine A Byrnes

Introduction

Parapneumonic empyema is defined by the collection of pus on the pleural surfaces, and it represents one of the most common local complications of community-acquired pneumonia (CAP) in children.¹^‐⁵ It has been estimated that parapneumonic effusions develop in about 1 in 100-150 children with CAP⁶^,⁷ but they could be discovered in as many as 40% of hospitalised children with CAP.⁸

CAP, are caused mainly by Streptococcus pneumoniae⁹ and their incidence has shown fluctuations over time. In particular, a significant global reduction in pneumococcal disease and mortality rates has been reported after the introduction of heptavalent pneumococcal conjugate vaccine (PCV7), which covers serotypes 4, 6B, 9V, 14, 18C, 19F and 23F, into the standard childhood immunisation schedule.¹⁰ In the following years, however, in the USA an increase in pneumococcal empyema, related to serotypes not covered by PCV7, has been reported.¹¹ After the replacement of the PCV7 with the PCV13, which covers also serotypes 1, 3, 5, 6A, 7F and 19 A, there has been a significant reduction in incidence and rate of hospitalisation for empyema.¹² The introduction of PCV13 is particularly important in consideration of the strong correlation between parapneumonic empyema and serotype 1 of pneumococcus.¹³

Other bacteria seem to be less frequently pathogens of CAP. However, other possible bacterial pathogens of parapneumonic empyema are represented by group A Streptococcus and Staphylococcus aureus.¹³

Clinical presentation of parapneumonic empyema is similar to that of uncomplicated CAP. The presence of an empyema should be suspected in children with prolonged fever (more or equal to 7 days) and in those who do not improve after 48-72 hours of adequate antibiotic therapy.⁹^,¹³ In physical examination, typically, parapneumonic empyema is characterized by decreased air entry breath and dullness to percussion.⁹

A clinical suspect of parapneumonic empyema should be confirmed performing a chest X-ray and/or pulmonary ultrasound. Ultrasound technique has a higher sensitivity than radiograph in determining extension and nature of fluid collection and it is very useful for monitoring children with empyema, considering that it does not expose to X-rays. Thoracic CT is not considered a first line exam in order to make diagnosis of empyema, but it should be performed when it is not possible to make a clear diagnosis or when there is a suspect of malignancies (i.e. Burkitt’s lymphoma).

All cases of parapneumonic empyema should be treated with empiric intravenous antibiotic therapy, covering Streptococcus pneumoniae, Streptococcus pyogenes and Staphylococcus aureus. However, in case of large effusion (> 2 cm) or compromission of respiratory function a chest drainage is essential.⁵^,¹⁴ Chest drainage is generally performed under ultrasound guide and children should be under sedation/general anaesthesia.¹⁴ Intrapleural fibrinolytics (i.e. urokinase) are particularly useful in shortening hospitalisation in cases where drainage is slow, in consideration of thick or loculated fluid.⁵^,¹⁴ Thoracic surgery should be taken in consideration in cases of failure of antibiotic therapy, chest drainage and fibrinolytics. However, guidelines are unclear about which surgical procedure is best and at which timing, as well duration of drainage or of antibiotic therapy, including optimal timing about oral shift and how these issues reflect on outcomes.

This scoping review aims to analyse the optimal antibiotic therapy, defining antibiotic molecule, route of administration and duration of antimicrobial therapy.

Review questions

Considering the importance of a mutual consensus in the clinical management of parapneumonic empyema in children, as documented in the available literature,¹⁵ the main review question will be: what is the available literature about the most appropriate antibiotic treatment for paediatric PE in terms of first-line agents choice, dose, route of administration and duration?

This review will also assess the following sub-questions:

1. Which are the most frequently reported pathogens and what is their antibiotic susceptibility profile?
2. Which outcomes and complication rates of PE are the most frequently reported in literature? Which are the most frequently reported treatments, both conservative or invasive, and which leads to improved outcomes and shorter length of stay?

Inclusion criteria

Participants

This review will include studies performed on children and adolescents (younger than 18 years) with a confirmed diagnosis of empyema, defined as the presence of pus within the pleural cavity. The diagnosis of empyema is established by the presence of pus, positive Gram's stain, or culture, or nucleic-acid amplification tests, in the pleural fluid. We will only include studies that have documented at leaast one of the following: the microbiological aetiologies, performed antimicrobial and surgical therapies, as well outcomes (at least at time of discharge). Only studies in English will be included. Empyema due to tuberculosis will be excluded.

Concept

The main concept of this review will be empyema in all its aspects, with a particular focus on treatment options.

Context

Considering the severity of the disease, we will not expect to find articles involving patients not hospitalized so we will include only inpatients.

Type of sources

This review will include both randomized controlled trials and non-randomized controlled trials. All the types of observational studies, prospective and retrospective (including case-control, cohort and cross-sectional studies, small case series or single case reports) will be included.

Methods

Search strategy

The search will be performed by one reviewer. We started our research in April 2023 in the following bibliographic databases: PubMed and SCOPUS. There will be date restrictions: we will search from the 1st of January 2000 to 31st of March 2023. Only articles written in English will be included. The search strategy will include a combination of the following word and their synonymous: “pediatric”, “empyema”, “pleural effusion” and “treatment”. The search strategy for PubMed is available in the extended data section of this protocol; the terms used for this search will be adapted for use with other bibliographic database.

Study selection

After the search, the studies will be exported to Rayyan. A first screen to exclude duplicates will be performed by one author.

Titles and/or abstracts of studies retrieved using the search strategy will be screened independently by two reviewers to identify studies that could be inserted reviewed. Full texts of potentially eligible studies will be retrieved and independently assessed for eligibility by two reviewers. Each researcher will be blinded to the decision of the other researcher. Any disagreement between them over the eligibility of studies will be resolved through discussion and, in case of further disagreement, by discussion with a third reviewer.

All the studies that will not meet the inclusion criteria will be excluded and a table with the reason why those studies were excluded will be inserted in the final manuscript.

The results of the search will be reported in the PRISMA flow diagram.

Data extraction

Two review authors will extract data independently, both on a different Excel spreadsheet. Each researcher will be blinded to the decision of the other researcher. When the process will be completed, in case of discordance, any disagreement will be identified and resolved through discussion (with a third author if necessary).

An Excel file will be used to store data. When available, extracted information will include:

1. study general features: title, author, year of publication, type of study, number of patients included in the study, geographical area where the study has been performed
2. participant general features: sample size of each group, nationality, age, socio-economic status, comorbidities
3. clinical manifestation of the condition: fever (including days), cough with mucus, dyspnoea, chest pain and others.
4. main imaging findings: type of lung involvement at chest X-Ray and/or CT scan, type of CNS involvement at CT scan or MRI, type of skin involvement evaluated by ultrasound or CT scan or MRI, heart (US or CT or MRI)
5. characteristics of eventual antimicrobial treatments performed during the empyema (length of therapy, when this has been started and which antibiotic was used)
6. adjunctive treatments performed and length of therapy during the empyema (e.g., steroids or other immunomodulatory medications)
7. surgical treatments performed and length of therapy during the empyema (e.g., drainage or thoracoscopy or surgical resection)
8. outcomes (admission to intensive care, death, survival; survival with sequelae; type of sequelae)

Data analysis and presentation

To report our findings, we will follow Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist.

We will produce a narrative synthesis of the findings from the studies included in the review describing the results we have obtained and providing our opinion on their interpretation. A particular focus with a narrative synthesis will be performed for antimicrobial and surgical therapy characteristics in terms of frequency of antibiotic choice, efficacy, and duration of therapy.

We will also use tables and charts to summarize both study characteristics and the most important clinical, diagnostics, treatments, and outcomes data.

More specifically, we will summarize our findings using different tables. The first one will include the characteristics of included studies (number of studies, study design, year of publication, characteristics of the study populations and countries where studies were conducted) and the participant general features. Then we will provide different tables or figures summarizing main data about clinical presentation, imaging characteristics, treatments performed, outcomes and predictors of empyema. We will also evaluate outcomes and treatment approaches according to the different aetiologies.

This way we hope we will be able to provide a useful document containing what is currently known of pediatric empyema with the aim of informing clinicians about the general characteristics of these conditions, focusing on risk factors and early clinical features, and guide future research projects to fill current gaps.

Study status

Protocol has been submitted and researched launched on the different datasets. Abstract screening will start after protocol submission.

Patient and public involvement

There was no direct patient and public involvement in this review. However, the key questions that led us implementing this research project were inspired by public discussions started by family associations in the media, highlighting the importance of better comprehension of how empyema can be recognized earlier in the disease course (before clinical conditions deteriorates and cannot be controlled anymore), or empyema may also be prevented if this complication is a consequence of a previous unrecognized and untreated lung infection.

Strengths and limitations of this study

• A scoping review can represent the best way to report on the types of evidence that are published in a certain field and our paper will provide an overview of empyema, focusing on predictors of positive outcomes.
• A scoping review can represent the best way to examine this field to guide future research on this topic.
• To report our findings, we will follow the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist to ensure methodological strength to our paper.
• Only two databases were screened, and only English paper will be considered limiting the number of papers that will be included.
• No critical appraisal neither risk of bias of the included studies will be performed, considering the exploratory role of this paper.

Data availability

Underlying data

No data are associated with your article.

Extended data

Open Science Framework: Therapy of parapneumonic empyema in children: protocol for a scoping review of the literature, https://doi.org/10.17605/OSF.IO/J58DR.¹⁶

References

1. Maffey A, Colom A, Venialgo C, et al.: Clinical, functional, and radiological outcome in children with pleural empyema. Pediatr. Pulmonol. 2019 May; 54(5): 525–530. PubMed Abstract | Publisher Full Text
2. Krenke K, Sadowy E, Podsiadły E, et al.: Etiology of parapneumonic effusion and pleural empyema in children. The role of conventional and molecular microbiological tests. Respir. Med. 2016 Jul; 116: 28–33. PubMed Abstract | Publisher Full Text | Free Full Text
3. Zhang X, Zhang H: Microbiological characteristics and outcomes of children with pleural empyema admitted to a tertiary hospital in southeast China, 2009-2018. Turk. J. Pediatr. 2021; 63(6): 994–1003.
4. Liese JG, Schoen C, van der Linden M , et al.: Changes in the incidence and bacterial aetiology of paediatric parapneumonic pleural effusions/empyema in Germany, 2010-2017: a nationwide surveillance study. Clin. Microbiol. Infect. 2019 Jul; 25(7): 857–864. PubMed Abstract | Publisher Full Text
5. Pabary R, Balfour-Lynn IM: Complicated pneumonia in children. Breathe (Sheff.). 2013; 9: 210–222. Publisher Full Text
6. Sonnappa S, Jaffe A: Treatment approaches for empyema in children. Paediatr. Respir. Rev. 2007; 8: 164–170. Publisher Full Text
7. Chonmaitree T, Powell KR: Parapneumonic pleural effusion and empyema in children. Review of a 19-year experience, 1962-1980. Clin. Pediatr. (Phila). 1983 Jun; 22(6): 414–419. PubMed Abstract | Publisher Full Text
8. Hamm H, Light RW: Parapneumonic effusion and empyema. Eur. Respir. J. 1997 May; 10(5): 1150–1156. PubMed Abstract | Publisher Full Text
9. de Benedictis FM , Kerem E, Chang AB, et al.: Complicated pneumonia in children. Lancet. 2020 Sep 12; 396(10253): 786–798. PubMed Abstract | Publisher Full Text
10. Fitzwater SP, Chandran A, Santosham M, et al.: The worldwide impact of the seven-valent pneumococcal conjugate vaccine. Pediatr. Infect. Dis. J. 2012; 31: 501–508. PubMed Abstract | Publisher Full Text
11. Byington CL, Korgenski K, Daly J, et al.: Impact of the pneumococcal conjugate vaccine on pneumococcal parapneumonic empyema. Pediatr. Infect. Dis. J. 2006; 25: 250–254. PubMed Abstract | Publisher Full Text
12. Wiese AD, Griffin MR, Zhu Y, et al.: Changes in empyema among U.S. children in the pneumococcal conjugate vaccine era. Vaccine. 2016 Dec 7; 34(50): 6243–6249. Epub 2016 Nov 7. PubMed Abstract | Publisher Full Text | Free Full Text
13. Harris M, Clark J, Coote N, et al.: British Thoracic Society Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax. 2011 Oct; 66 Suppl 2: ii1–ii23. PubMed Abstract | Publisher Full Text
14. Balfour-Lynn IM, Abrahamson E, Cohen G, et al.: BTS guidelines for the management of pleural infection in childrenThorax.2005; 60: i1–i21.
15. Hafen GM, Grenzbach AC, Moeller A, et al.: Lack of concordance in parapneumonic effusion management in children in central Europe. Pediatr. Pulmonol. 2016 Apr; 51(4): 411–417. PubMed Abstract | Publisher Full Text
16. Buonsenso D: Therapy of parapneumonic empyema in children: protocol for a scoping review of the literature.2023, June 3. Publisher Full Text

Comments on this article Comments (1)

Version 2

VERSION 2 PUBLISHED 03 Jun 2024

Revised

Reader Comment 21 Jun 2024

Biju S Punnooreth null, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India

21 Jun 2024

Reader Comment

This protocol highlights the need for review on the topic, However it is not specified about whether you will be including articles discussed about COVID-19 related empyema. Or are you ... Continue reading This protocol highlights the need for review on the topic, However it is not specified about whether you will be including articles discussed about COVID-19 related empyema. Or are you including all the literatures which discuss about empyema, irrespective of the cause.
This protocol highlights the need for review on the topic, However it is not specified about whether you will be including articles discussed about COVID-19 related empyema. Or are you including all the literatures which discuss about empyema, irrespective of the cause.
Competing Interests: I declare no competing interest in the review process Close
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Author details Author details

Francesca Cusenza
Roles: Data Curation, Formal Analysis, Investigation

Lucrezia Passadore
Roles: Data Curation, Formal Analysis, Investigation

Francesca Bonanno
Roles: Data Curation, Formal Analysis, Investigation

Carolina Calanca
Roles: Data Curation, Formal Analysis, Investigation

Sonia Rasmi
Roles: Data Curation, Formal Analysis, Investigation

Francesco Mariani
Roles: Conceptualization, Data Curation, Funding Acquisition, Investigation

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (2)

version 2

Revised

Published: 03 Jun 2024, 12:1527

https://doi.org/10.12688/f1000research.135295.2

version 1

Published: 28 Nov 2023, 12:1527

https://doi.org/10.12688/f1000research.135295.1

© 2024 Buonsenso D et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Buonsenso D, Cusenza F, Passadore L et al. Therapy of parapneumonic empyema in children: a protocol for a scoping review of the literature [version 2; peer review: 2 approved]. F1000Research 2024, 12:1527 (https://doi.org/10.12688/f1000research.135295.2)

NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.

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Open Peer Review

Version 2

VERSION 2

PUBLISHED 03 Jun 2024

Revised

Views

Reviewer Report 01 Aug 2024

Catherine A Byrnes, Auckland District Health Board, Starship Children's Health, Auckland, New Zealand

Approved

https://doi.org/10.5256/f1000research.167272.r285922

Thanks - I think the changes are appropriate.

I think it looks good for indexing.

I have a couple of minor English edits to make to read correctly (but if you make those changes ... Continue reading

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Reviewer Report 27 Jun 2024

King-Pui Florence Chan, University of Hong Kong, Queen Mary Hospital,, Hong Kong, Hong Kong

Approved

https://doi.org/10.5256/f1000research.167272.r285923

Thank you for the amendment. The protocol ... Continue reading

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Version 1

VERSION 1

PUBLISHED 28 Nov 2023

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Reviewer Report 28 May 2024

King-Pui Florence Chan, University of Hong Kong, Queen Mary Hospital,, Hong Kong, Hong Kong

Approved with Reservations

https://doi.org/10.5256/f1000research.148406.r272217

The study protocol aims to provide a literature review on children with pleural empyema. The protocol can be improved by further clarification.

1. In the method part, I am not aware of how the bacterial results is analyzed or included. Please consider elaborating it.

2. The severity of outcomes including intensive care unit stay can be included as analysis.

3. Some of the pleural empyema can be caused by tuberculosis, which the antimicrobial use would be different. Please consider to address this in the protocol.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Partly
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Respiratory Medicine, Respiratory infection, Epidemiology

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Author Response 21 Jun 2024

danilo buonsenso, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy, Rome, Italy

21 Jun 2024

Author Response

thank you, I have responded to your main comments
Competing Interests: No competing interests were disclosed.
thank you, I have responded to your main comments
thank you, I have responded to your main comments
Competing Interests: No competing interests were disclosed. Close
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COMMENTS ON THIS REPORT

Author Response 21 Jun 2024

danilo buonsenso, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy, Rome, Italy

21 Jun 2024

Author Response

thank you, I have responded to your main comments
Competing Interests: No competing interests were disclosed.
thank you, I have responded to your main comments
thank you, I have responded to your main comments
Competing Interests: No competing interests were disclosed. Close
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Reviewer Report 15 May 2024

Catherine A Byrnes, Auckland District Health Board, Starship Children's Health, Auckland, New Zealand

Approved with Reservations

https://doi.org/10.5256/f1000research.148406.r245793

Generally this is a good proposal – responding to queries and questions generated from patients and using Prism as the backbone which is good.

Not much is mentioned regarding chest drains – nil in abstract, not

Generally this is a good proposal – responding to queries and questions generated from patients and using Prism as the backbone which is good.

Not much is mentioned regarding chest drains – nil in abstract, not till the 2^nd to last paragraph in the introduction and as part of the Qs – mentioned in passing. The authors need to clarify this a bit more. Is chest drainage and/or video assisted thoroscopic surgery going to be included?
Articles only in English or other languages. The authors should define the languages of the articles they are searching in.
Only including patients that have an identified organism – many patients are difficult to get a positive culture from – and often the published articles have some with identified organisms and some without – yet the authors here are only including those where bacteria have been isolated – can they clarify this?
If greater than 100 articles – will then restrict to last 5 years – better if stuck to the whole. Either do all articles or restrict to 5 years - wouldn't go with the number being a restriction.
Note that although this is being presented as a protocol, the review has already started.
In the selected word options for search – no “pleural effusion”. The authors have given the search words they have used but have not included "pleural effusion".

The manuscript could do with some English editing - I appreciate that the authors are likely writing this in a second language. Some editing is needed to put some of the phrasing into correct grammatical English.

Abstract:

“are still a matter for debate”
“their abstracts” → “the abstracts”
“then their full text” → “then the full text”
“detecting” → “determine”
“when the process will be completed” → “is completed”
“with help, when needed, of a third” → “with help of a third”

Introduction:

“discovered’ → seen or recognised or discerned (para 1)
“their” → “the” (para 2)
“less frequently” → “less frequent” (para 3)
“suspect” → “suspicion” (para 5)
“radiograph” → “radiography” (para 5)
“xray” → “radiation”

Review Qs:

“as literature points out” → “as documented in the available literature”

Methods:

“inserted in the review” → “reviewed”

Data Extraction:

“everyone” → “both”

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Partly
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Paediatric Respiratory disease

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Author Response 21 Jun 2024

danilo buonsenso, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy, Rome, Italy

21 Jun 2024

Author Response

thank you very much, we changed as you suggested
Competing Interests: nothing
thank you very much, we changed as you suggested
thank you very much, we changed as you suggested
Competing Interests: nothing Close
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COMMENTS ON THIS REPORT

Author Response 21 Jun 2024

danilo buonsenso, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy, Rome, Italy

21 Jun 2024

Author Response

thank you very much, we changed as you suggested
Competing Interests: nothing
thank you very much, we changed as you suggested
thank you very much, we changed as you suggested
Competing Interests: nothing Close
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Comments on this article Comments (1)

Version 2

VERSION 2 PUBLISHED 03 Jun 2024

Revised

Reader Comment 21 Jun 2024

Biju S Punnooreth null, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India

21 Jun 2024

Reader Comment

This protocol highlights the need for review on the topic, However it is not specified about whether you will be including articles discussed about COVID-19 related empyema. Or are you ... Continue reading This protocol highlights the need for review on the topic, However it is not specified about whether you will be including articles discussed about COVID-19 related empyema. Or are you including all the literatures which discuss about empyema, irrespective of the cause.
This protocol highlights the need for review on the topic, However it is not specified about whether you will be including articles discussed about COVID-19 related empyema. Or are you including all the literatures which discuss about empyema, irrespective of the cause.
Competing Interests: I declare no competing interest in the review process Close
Report a concern
Comment

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Version 1 28 Nov 23	read	read

Catherine A Byrnes, Starship Children's Health, Auckland, New Zealand
King-Pui Florence Chan, University of Hong Kong, Queen Mary Hospital,, Hong Kong, Hong Kong

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01 Aug 2024 | for Version 2

Catherine A Byrnes, Auckland District Health Board, Starship Children's Health, Auckland, New Zealand

3 Views Cite this report Responses(0)

Approved

Thanks - I think the changes are appropriate.

I think it looks good for indexing.

I have a couple of minor English edits to make to read correctly (but if you make those changes it can go straight to indexing )

Intro para 5 'a suspicion of malignancies'
Intro para 6 ''or compromising respiratory function'
intro para 6 'including optimal timing about shifting to oral antibiotics and'
intro para 7 'defining antibiotic of choice'
participants 'as well as outcomes'
study selection 'could be reviewed' (delete 'inserted')
data extraction 'when the process is completed'

that's it - thanks

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Reviewer Expertise

Paediatric Respiratory disease

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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27 Jun 2024 | for Version 2

King-Pui Florence Chan, University of Hong Kong, Queen Mary Hospital,, Hong Kong, Hong Kong

3 Views Cite this report Responses(0)

Approved

Thank you for the amendment. The protocol was revised with appropriate response to the comments.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Respiratory Medicine, Respiratory infection, Epidemiology

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report

5 Views

28 May 2024 | for Version 1

King-Pui Florence Chan, University of Hong Kong, Queen Mary Hospital,, Hong Kong, Hong Kong

5 Views Cite this report Responses(1)

Approved With Reservations

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Partly
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Respiratory Medicine, Respiratory infection, Epidemiology

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7 Views

15 May 2024 | for Version 1

Catherine A Byrnes, Auckland District Health Board, Starship Children's Health, Auckland, New Zealand

7 Views Cite this report Responses(1)

Approved With Reservations

Generally this is a good proposal – responding to queries and questions generated from patients and using Prism as the backbone which is good.

Not much is mentioned regarding chest drains – nil in abstract, not till the 2^nd to last paragraph in the introduction and as part of the Qs – mentioned in passing. The authors need to clarify this a bit more. Is chest drainage and/or video assisted thoroscopic surgery going to be included?
Articles only in English or other languages. The authors should define the languages of the articles they are searching in.
Only including patients that have an identified organism – many patients are difficult to get a positive culture from – and often the published articles have some with identified organisms and some without – yet the authors here are only including those where bacteria have been isolated – can they clarify this?
If greater than 100 articles – will then restrict to last 5 years – better if stuck to the whole. Either do all articles or restrict to 5 years - wouldn't go with the number being a restriction.
Note that although this is being presented as a protocol, the review has already started.
In the selected word options for search – no “pleural effusion”. The authors have given the search words they have used but have not included "pleural effusion".

“are still a matter for debate”
“their abstracts” → “the abstracts”
“then their full text” → “then the full text”
“detecting” → “determine”
“when the process will be completed” → “is completed”
“with help, when needed, of a third” → “with help of a third”

Introduction:

“discovered’ → seen or recognised or discerned (para 1)
“their” → “the” (para 2)
“less frequently” → “less frequent” (para 3)
“suspect” → “suspicion” (para 5)
“radiograph” → “radiography” (para 5)
“xray” → “radiation”

Review Qs:

“as literature points out” → “as documented in the available literature”

Methods:

“inserted in the review” → “reviewed”

Data Extraction:

“everyone” → “both”

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Partly
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Paediatric Respiratory disease

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Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

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[3] 3. Zhang X, Zhang H: Microbiological characteristics and outcomes of children with pleural empyema admitted to a tertiary hospital in southeast China, 2009-2018. Turk. J. Pediatr. 2021; 63(6): 994–1003.

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[7] 7. Chonmaitree T, Powell KR: Parapneumonic pleural effusion and empyema in children. Review of a 19-year experience, 1962-1980. Clin. Pediatr. (Phila). 1983 Jun; 22(6): 414–419. PubMed Abstract | Publisher Full Text

[8] 8. Hamm H, Light RW: Parapneumonic effusion and empyema. Eur. Respir. J. 1997 May; 10(5): 1150–1156. PubMed Abstract | Publisher Full Text

[9] 9. de Benedictis FM , Kerem E, Chang AB, et al.: Complicated pneumonia in children. Lancet. 2020 Sep 12; 396(10253): 786–798. PubMed Abstract | Publisher Full Text

[10] 10. Fitzwater SP, Chandran A, Santosham M, et al.: The worldwide impact of the seven-valent pneumococcal conjugate vaccine. Pediatr. Infect. Dis. J. 2012; 31: 501–508. PubMed Abstract | Publisher Full Text

[11] 11. Byington CL, Korgenski K, Daly J, et al.: Impact of the pneumococcal conjugate vaccine on pneumococcal parapneumonic empyema. Pediatr. Infect. Dis. J. 2006; 25: 250–254. PubMed Abstract | Publisher Full Text

[12] 12. Wiese AD, Griffin MR, Zhu Y, et al.: Changes in empyema among U.S. children in the pneumococcal conjugate vaccine era. Vaccine. 2016 Dec 7; 34(50): 6243–6249. Epub 2016 Nov 7. PubMed Abstract | Publisher Full Text | Free Full Text

[13] 13. Harris M, Clark J, Coote N, et al.: British Thoracic Society Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax. 2011 Oct; 66 Suppl 2: ii1–ii23. PubMed Abstract | Publisher Full Text

[14] 14. Balfour-Lynn IM, Abrahamson E, Cohen G, et al.: BTS guidelines for the management of pleural infection in childrenThorax.2005; 60: i1–i21.

[15] 15. Hafen GM, Grenzbach AC, Moeller A, et al.: Lack of concordance in parapneumonic effusion management in children in central Europe. Pediatr. Pulmonol. 2016 Apr; 51(4): 411–417. PubMed Abstract | Publisher Full Text

[16] 16. Buonsenso D: Therapy of parapneumonic empyema in children: protocol for a scoping review of the literature.2023, June 3. Publisher Full Text

Therapy of parapneumonic empyema in children: a protocol for a scoping review of the literature

Abstract

Background

Methods

Dissemination

Keywords

Revised Amendments from Version 1

Introduction

Review questions

Inclusion criteria

Participants

Concept

Context

Type of sources

Methods

Search strategy

Study selection

Data extraction

Data analysis and presentation

Study status

Patient and public involvement

Strengths and limitations of this study

Data availability

Underlying data

Extended data

References

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