Pediatric empyema thoracis management: should the consensus be different for the developing countries?

Area of Science:

• Pediatric Thoracic Surgery
• Interventional Pulmonology
• Evidence-Based Medicine

Background:

• Pediatric empyema is prevalent in the Indian subcontinent, yet intrapleural fibrinolytic therapy (IFT) remains underutilized.
• Existing literature on IFT for pediatric empyema in developing countries is scarce.
• This study addresses potential epidemiological differences and physician bias influencing treatment choices.

Purpose of the Study:

• To determine the equivalence of fibrinolytic therapy to video-assisted thoracoscopic surgery (VATS) for stage II empyema in children.
• To evaluate treatment efficacy, complications, and cost-effectiveness in a developing country context.

Main Methods:

• A randomized controlled trial comparing IFT and VATS for stage II empyema in children.
• Outcomes assessed included hospital stay duration, therapeutic efficacy, complications, and cost.
• Study type: Randomized controlled trial, treatment study, and cost-effectiveness analysis.

Main Results:

• Successful empyema clearance was high in both groups: 90% for VATS (20 children) and 95.2% for IFT (21 children).
• Median hospital stay was similar (7 days for VATS vs. 8 days for IFT, p=0.24).
• VATS group required significantly more CT scans (p=0.02) and blood transfusions (p=0.000) than the IFT group.

Conclusions:

• Intrapleural fibrinolytic therapy is non-inferior to VATS for treating pediatric stage II empyema in the Indian subcontinent.
• IFT presents a potentially more cost-effective and less resource-intensive option.
• Further multicenter trials with larger sample sizes and standardized protocols are recommended to strengthen findings and reduce bias.