Comparison of urokinase and video-assisted thoracoscopic surgery for treatment of childhood empyema.
نویسندگان
چکیده
BACKGROUND Despite increasing incidence and morbidity, little evidence exists to inform the best management approach in childhood empyema. AIM To compare chest drain with intrapleural urokinase and primary video-assisted thoracoscopic surgery (VATS) for the treatment of childhood empyema. METHODS Children were prospectively randomized to receive either percutaneous chest drain with intrapleural urokinase or primary VATS. The primary outcome was the number of hospital days after intervention. Secondary end points were number of chest drain days, total hospital stay, failure rate, radiologic outcome at 6 mo, and total treatment costs. RESULTS Sixty children were recruited. The two groups were well matched for demographics; baseline characteristics; and hematologic, biochemical, and bacteriologic parameters. No significant difference was found in length of hospital stay after intervention between the two groups: VATS (median [range], 6 [3-16] d) versus urokinase (6 [4-25] d) (p = 0.311; 95% confidence interval, -2 to 1). No difference was demonstrated in total hospital stay: VATS versus urokinase (8 [4-17] d and 7 [4-25] d) (p = 0.645); failure rate: 5 (16.6%); and radiologic outcome at 6 mo after intervention in both groups. The mean (median) treatment costs of patients in the urokinase arm US dollars 9,127 (US dollars 6,914) were significantly lower than those for the VATS arm US dollars 11,379 (US dollars 10,146) (p < 0.001). CONCLUSIONS There is no difference in clinical outcome between intrapleural urokinase and VATS for the treatment of childhood empyema. Urokinase is a more economic treatment option compared with VATS and should be the primary treatment of choice. This study provides an evidence base to guide the management of childhood empyema.
منابع مشابه
Comparison of Video-Assisted Thoracoscopic Surgery and Intrapleural Urokinase as an Initial Treatment for Parapneumonic Effusion and Thoracic Empyema
Introduction: The treatment of complicated parapneumonic effusion (PPE) and thoracic empyema (TE) is controversial; and the choice of treatment after confirming the failure of simple drainage remains unclear. The purpose of this study was to compare the outcomes of intrapleural urokinase (UK) administration and video-assisted thoracoscopic surgery (VATS) as initial treatment options for PPE and...
متن کاملComparison of Video-Assisted Thoracoscopic Surgery and Intrapleural Urokinase as an Initial Treatment for Parapneumonic Effusion and Thoracic Empyema
متن کامل
Update on the causes, investigation and management of empyema in childhood.
Despite being recognised for over two millennia and having an increasing incidence in many countries, the management of childhood empyema remains controversial. This review examines the recent literature on its causes and investigation then focuses on its treatment. Following a trial of appropriate intravenous antibiotics, the evidence would currently support the use of chest drain insertion wi...
متن کاملUrokinase versus VATS for treatment of empyema: a randomized multicenter clinical trial.
BACKGROUND AND OBJECTIVE Parapneumonic empyema (PPE) is a frequent complication of acute bacterial pneumonia in children. There is limited evidence regarding the optimal treatment of this condition. The aim of this study was to compare the efficacy of drainage plus urokinase versus video-assisted thoracoscopic surgery in the treatment of PPE in childhood. METHODS This prospective, randomized,...
متن کاملVATS or urokinase for treatment of empyema?
This randomized, multicenter clinical trial enrolled 103 children hospitalized with septated parapneumonic empyema (PPE) who were randomized to receive thoracoscopy (n=53) or urokinase (n=50). The main outcome variable was the length of hospital stay after treatment. The secondary outcomes were total length of hospital stay, number of days with the chest drain, number of days with fever, and tr...
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ورودعنوان ژورنال:
- American journal of respiratory and critical care medicine
دوره 174 2 شماره
صفحات -
تاریخ انتشار 2006