VATS 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 treatment failures. No statistically significant differences were found between thoracoscopy and urokinase in the median postoperative stay (10 vs 9 days), median hospital stay (14 vs 13 days), or days febrile after treatment (4 vs 6 days). A second intervention was required in 15% of children in the thoracoscopy group versus 10% in the urokinase group (P = 0.47). The authors concluded that drainage plus urokinase instillation is as effective as video-assisted thoracoscopic surgery as firstline treatment of septated PPE in children.