Efficacy of Chest Drain and Fibrinolytic Therapy for Paediatric Empyema: A Single-Centre Retrospective Review

Abstract

Background: Managing paediatric empyema sparks controversy in the literature, with the debate centered on chest drain with fibrinolytic therapy versus Video-Assisted Thoracoscopic Surgery (VATS).Objectives: Retrospective evaluation of the management of paediatric empyema with chest drain and fibrinolytic therapy in relation to success of the intervention, total hospital stays and readmission rate.Patients and methods: All children less than 16 years diagnosed with empyema between January 2015, and January 2020 admitted to our centre and received primary intervention in the form of chest drain with fibrinolytic therapy were identified from the hospital database. patient records were retrospectively reviewed to obtain patient demographics, days of symptoms before admission, preoperative inflammatory markers (WBC and CRP), chest x-ray and chest ultrasound scan, oxygen requirement before intervention, hospital stay before intervention. Overall outcome (we defined success of the primary intervention by being curative with no need for secondary intervention), Hospital stay and readmission rate. Patients with other comorbidities, those with bleeding disorders and those who received primary intervention in their local hospital or received VATS were excluded from our study.Results: In total 63 children underwent chest drain insertion with urokinase administration as a primary intervention for empyema during the study period with overall success rate 84.1% (53/63). The median for the total hospital stay was 12.0 (7.0-36.0) days, and the readmission rate was 4.8 % (3/63). Using smaller size chest drain was not associated with increased risk of requiring secondary intervention or prolonged hospital stay in comparison with bigger size drains.Conclusion: Despite the ongoing debate among different paediatric surgery centres regarding the management of paediatric empyema, our study indicates that chest drain insertion with fibrinolytic therapy is a reasonable and less invasive approach with a high success rate. Further analysis is needed to identify prognostic factors that might favour primary VATS.