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

Gowri Shankar1, Ravindra Sahadev1, Ramesh Santhanakrishnan1

  • 1Department of Pediatric Surgery, Indira Gandhi Institute of Child Heath, Bangalore-29.

Journal of Pediatric Surgery
|September 15, 2019
PubMed
Summary

Intrapleural fibrinolytic therapy (IFT) is as effective as video-assisted thoracoscopic surgery (VATS) for treating pediatric stage II empyema in the Indian subcontinent. This study suggests IFT is a viable, cost-effective alternative in developing countries.

Keywords:
Empyema thoracis stage IIFibrinopurulent empyemaIntrapleural fibrinolysisRandomized control studyUrokinaseVideo-assisted thoracoscopic surgery

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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.