Experience with an evidence-based protocol using fibrinolysis as first line treatment for empyema in children.

Document Type


Publication Date



DOI: 10.1016/j.jpedsurg.2013.03.029


INTRODUCTION: We previously reported a prospective, randomized trial comparing video-assisted thoracoscopic decortication (VATS) to fibrinolysis for the treatment of empyema. In that study no advantages to VATS were identified, although VATS resulted in significantly higher hospital charges. We subsequently implemented the algorithm from the trial utilizing primary fibrinolytic therapy in all children diagnosed with empyema. In this study, we reviewed our experience to examine the clinical efficacy of this protocol.

METHODS: After IRB approval, we conducted a retrospective review of all children diagnosed with empyema as all were treated with the fibrinolysis protocol utilized in the prospective trial since the completion of the trial.

RESULTS: In 102 consecutive patients treated with fibrinolysis, 16 patients (15.7%) required subsequent VATS. No patients were treated with initial VATS. No major side effects were seen from fibrinolytic therapy. Mean operative time for VATS after fibrinolysis was 62 minutes. The length of stay after VATS was 5.9 days.

CONCLUSIONS: The results of an evidence-based protocol using fibrinolysis to treat empyema have replicated the results of the trial that led to the implementation of the protocol. The pediatric empyema population can be successfully treated without an operation in the majority of cases.

Journal Title

Journal of pediatric surgery





First Page


Last Page


MeSH Keywords

Algorithms; Child; Child, Preschool; Clinical Protocols; Combined Modality Therapy; Decision Support Techniques; Drug Administration Schedule; Empyema, Pleural; Evidence-Based Medicine; Female; Fibrinolytic Agents; Humans; Infant; Length of Stay; Male; Retrospective Studies; Suction; Thoracic Surgery, Video-Assisted; Thoracostomy; Tissue Plasminogen Activator; Treatment Outcome


Children; Empyema; Fibrinolysis; VATS; tPA

Library Record