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Use of Tissue Plasminogen Activator in Abdominal Abscesses in Children-A Single-Center Randomized Control Trial
Craig R Gibson1,2, Afsaneh Amirabadi3, Simal Goman1
1Image Guided Therapy, Diagnostic Imaging, 7979The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Intracavitary tissue plasminogen activator (tPA) did not significantly improve outcomes for pediatric intra-abdominal abscesses compared to saline. Further multicenter studies are needed to definitively assess tPA
Area of Science:
- Pediatric Surgery
- Interventional Radiology
- Medical Microbiology
Background:
- Intra-abdominal abscesses in children often require drainage and can lead to prolonged hospital stays.
- Tissue plasminogen activator (tPA) is a fibrinolytic agent that has been explored to enhance abscess drainage.
- The efficacy of intracavitary tPA in pediatric intra-abdominal abscesses remains to be definitively established.
Purpose of the Study:
- To evaluate the effectiveness of once-daily intracavitary tissue plasminogen activator (tPA) for treating pediatric intra-abdominal abscesses.
- To compare tPA treatment with saline instillation in a randomized controlled trial setting.
Main Methods:
- A prospective, double-blinded, randomized controlled trial was conducted in a single center.
- Pediatric patients with intra-abdominal abscesses were randomized to receive either tPA or saline instillation via drainage catheter.
- Primary outcome was drainage catheter dwell time; secondary outcomes included length of hospital stay, time to discharge, resolution, and adverse events.
Main Results:
- Twenty-eight children were randomized (14 per group) with no significant demographic differences.
- The tPA group had a higher number of abscesses (P = .03).
- No significant differences were observed in catheter dwell time (P = .077), length of stay, time to discharge, or resolution between the tPA and saline groups. No drug-related adverse events occurred.
Conclusions:
- Intracavitary tPA did not demonstrate a significant benefit over saline in reducing catheter dwell time or improving other clinical outcomes for pediatric intra-abdominal abscesses.
- The study found no increased morbidity or mortality associated with intracavitary tPA.
- Results neither support nor refute the routine use of tPA; larger multicenter trials are recommended.
Purpose:
To establish the efficacy of once-per-day intracavitary tissue plasminogen activator (tPA) in the treatment of pediatric intra-abdominal abscesses.
Methods:
A single-center prospective, double-blinded, randomized controlled trial of the use of intracavitary tPA in abdominal abscesses in children. Patients were randomized to either tPA-treatment or saline-treatment groups. Primary outcome was drainage catheter dwell (hours). Secondary outcomes were length of hospital stay, times to discharge, clinical and sonographic resolution, and adverse events (AEs).
Results:
Twenty-eight children were randomized to either group (n = 14 each). Demographics between groups were not significantly different (age P = .28; weight P = .40; gender P = .44). There were significantly more abscesses in the tPA-treated group (P = .03). Abscesses were secondary to perforated appendicitis (n = 25) or postappendectomy (n = 3). Thirty-four abscesses were drained, 4 aspirated, 3 neither drained/aspirated. There was no significant difference in number of drains (P = .14), drain size (P = .19), primary outcome (P = .077), or secondary outcomes found. No procedural or intervention drug-related AEs occurred. No patient in the saline-treated group required to be switched/treated with tPA.
Conclusion:
No significant difference in the length of catheter dwell time, procedure time to discharge, or time to resolution was found. Intracavitary tPA was not associated with morbidity or mortality. The results neither support nor negate routine use of tPA in the drainage of intra-abdominal abscess in children. It is possible that a multicentre study with a larger number of patients may answer this question more definitively.
