Contemporary use of fibrinolytics in the management of pediatric empyema
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In brief
In brief
This multi-center study analyzed 581 pediatric empyema cases from 2018-2023, finding that fibrinolysis with chest drainage is now the predominant first-line treatment (67.6% of cases) and demonstrates comparable outcomes to surgical approaches with fewer complications. The research supports fibrinolysis as an effective, less invasive primary therapy option for pediatric empyema management.
- Fibrinolysis with chest drainage is now the most common first-line treatment for pediatric empyema (67.6% of cases in 2018-2023).
- Length of stay did not differ significantly between fibrinolysis, chest drainage alone, or surgical approaches after adjusting for covariates.
- Only 6.9% of patients treated with fibrinolysis required subsequent VATS/decortication, demonstrating high effectiveness as primary therapy.
- VATS/open decortication had higher complication rates (11.7%) compared to chest drainage with fibrinolysis (4.1%) or drainage alone (5.8%).
- 30-day readmission rates were low and equivalent across all treatment approaches (approximately 1%), supporting fibrinolysis as safe first-line therapy.
Written by the GCMD Library team from the article.
Abstract
Background
This study seeks to investigate the contemporary use and effectiveness of fibrinolysis as a first-line option in pediatric empyema.
Methods
The Pediatric Health Information System (PHIS) was queried to identify patients with empyema without fistula (2018–2023). First-line treatments were chest drainage (CD), chest drainage with fibrinolysis (CDF), and video-assisted thoracoscopic surgery/open decortication (VATS/OD). Outcomes between groups were compared using Kruskal–Wallis and Chi-Square tests. Multivariate generalized linear model was used to account for covariates.
Results
581 individuals/cases met inclusion criteria. CD accounted for 11.9% of cases, CDF for 67.6%, and VATS/OD for 20.7%. After adjusting for covariates differences in LOS were not significant (p = 0.393). Subsequent VATS/ODs were required in 6.9% of CDF cases, 8.9% of CD, and 3.3% of primary VATS/OD. Additionally, 32.5% of primary VATS/OD received adjuvant fibrinolysis. Complications were more often observed in the VATS/OD group compared to CD and CDF (11.7% vs 5.8% and 4.1% respectively; p = .008). There were no differences in 30-day readmission rate (VATS/OD:1.2%, CTD:1.5%, and CTDF:1%; p = 0.83).
Conclusion
Fibrinolysis is now utilized as first-line treatment for most patients and as adjunct in other approaches. The findings justify further implementation as it is the less invasive first-line primary therapy in patients with empyema.