Pediatric empyemas – Has the pendulum swung too far?

We read the article: “Pediatric empyemas – Has the pendulum swung too far?” by Derderian et al, with interest.1 The authors reported trends in the care of children with empyema from 2010 to 2017 using administrative data from the Pediatric Health Information System, which covers 52 tertiary care children's hospitals from across the United States. They found that the use of primary video-assisted thoracoscopic surgery (VATS) decreased from almost 40% in 2010 to less than 10% in 2017. Interestingly, the rate of rescue VATS after chest tube insertion and fibrinolytics remained low, varying between 4.1% and 9.2%.