Stages of Empyema thoracis (para-pneumonic)
  1. 1.Early/acute/serous stage, one or more of:

  2. pH < 7.2

  3. glucose < 40 mg/dL

  4. LDH >1000IU/dL

  5. protein > 2.5 g/dL

  6. WBC > 500/µL

  7. specific gravity greater than 1.018

  8. Thin serous or cloudy fluid, generally sterile

  9. 2.Fibrinopurulent/intermediate stage

  10. Thicker, opaque fluid or fluid with positive cultures

  11. 3.Organizing/late stage

  12. An organizing peel with entrapment of the lung


Severity Scoring of Empyema (SSE)

The following scoring system was described by Hoff et al to allow comparison of empyema thoracis in children.


  1. 1.Low pleural fluid pH (<7.2)

  2. 2.Low pleural fluid glucose (<40 mg.dl)

  3. 3.Significant scoliosis on CXR

  4. 4.Evidence of parenchymal entrapment

  5. 5.Anaerobic infection

One point is allocated to each parameter that is present. A total score of :

  1. 1.Mild disease (can be treated with antibiotics and thoracentesis

  2. 2.Moderate disease

  3. 3.Severe disease (will “defervesce” more rapidly with surgical decortication)

Hoff S, Neblett W, Edwards KM, Heller RM, Pietsch JB, Holcomb GW, Hocomb III GW. Parapneumonic empyema in children: decortication hastens recovery in patients with severe pleural infections. Pediatr Infect Dis J 1991; 10 : 194-199. 


A more comprehensive scoring system is outlined below:

Risk of poor outcome in patients with parapneumonic effusions and empyema