Pediatric Empyema Thoracis Management: Should the Consensus Be Different for the Developing Countries?
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Read the article on jpedsurg.org ↗Article · Sep 2019 · 1 min read
In brief
In brief
This randomized controlled trial from India compares intrapleural fibrinolytic therapy (IFT) to VATS for stage II pediatric empyema, finding IFT noninferior with 95% success versus 90% for VATS. IFT required fewer CT scans and blood transfusions, suggesting it may be a cost-effective alternative in resource-limited settings where empyema burden is high.
Written by the GCMD Library team from the article.
Background
Despite the available consensus, intrapleural fibrinolytic therapy (IFT) in pediatric empyema is grossly underutilized in the Indian subcontinent where the disease burden is huge. Possible reasons may be epidemiological differences and physician bias. There is a paucity of literature from developing countries on the use of IFT in pediatric empyema thoracis. Hence, this study was undertaken to determine if fibrinolytic therapy is equivalent to video-assisted thoracoscopic surgery (VATS) in treating stage II empyema in children even in developing countries.
Methods
Consecutive cases of stage II empyema were randomized to receive either IFT or VATS. The outcomes measured were the duration of hospital stay, efficacy of therapy, complications, and cost differences.
Results
41 children were randomized to either VATS (n = 20) or IFT (n = 21) group. Overall successful clearance of empyema was achieved in 18 out of 20 (90%) children undergoing VATS and 20 out of 21(95.2%) children in fibrinolytic arm. The median length of the hospital stay was 7 and 8 days for VATS and IFT groups respectively (p = .24). Need for CT scan and blood transfusion was significantly higher in the VATS group than IFT group (p = .02 and .000).
Conclusions
Fibrinolytic therapy is noninferior to VATS in the treatment of stage II empyema in children in the Indian subcontinent. A multicenter trial with larger sample size and uniform, detailed protocols on indications for CT scan, blood transfusions, nutrition status and costs involved will be needed to eliminate institutional bias and to increase the strength of the study.
Study type
Randomized controlled study, treatment study and cost effectiveness study.