Contemporary use of fibrinolytics in the management of pediatric empyema.

Creator(s)

Maria Grazia Sacco Casamassima, Children's Mercy Kansas CityFollow
Janelle R. Noel-Macdonnell PhD, Children's Mercy HospitalFollow
Tolulope A. Oyetunji MD MPH, Children's Mercy Kansas CityFollow
Shawn D. St Peter, Children's Mercy HospitalFollow

Document Type

Article

Publication Date

11-4-2024

Identifier

DOI: 10.1007/s00383-024-05868-w

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.

Journal Title

Pediatric surgery international

Volume

40

Issue

1

First Page

289

Last Page

289

MeSH Keywords

Humans; Female; Male; Child; Fibrinolytic Agents; Thoracic Surgery, Video-Assisted; Child, Preschool; Empyema, Pleural; Retrospective Studies; Infant; Adolescent; Drainage; Treatment Outcome; Thrombolytic Therapy

Keywords

Alteplase; Empyema; Fibrinolysis; PHIS; Pleural effusion; VATS

Recommended Citation

Sacco Casamassima MG, Noel-MacDonnell JR, Oyetunji TA, St Peter SD. Contemporary use of fibrinolytics in the management of pediatric empyema. Pediatr Surg Int. 2024;40(1):289. Published 2024 Nov 4. doi:10.1007/s00383-024-05868-w