ORIGINAL ARTICLE

Randomised trial of intrapleural urokinase in the treatment of childhood empyema

A H Thomson¹, J Hull¹, M R Kumar¹, C Wallis², I M Balfour Lynn³ On Behalf Of The British Paediatric Respiratory Society Empyema Study Group⁴

¹ John Radcliffe Hospital, Oxford, UK
² Great Ormond Street Hospital, London, UK
³ Royal Brompton and Harefield NHS Trust, London, UK
⁴ Members of the British Paediatric Respiratory Society Empyema Study Group: A Bush and M Rosenthal, Royal Brompton and Harefield NHS Trust, London; T Edmunds, Sick Children's NHS Trust Edinburgh; W Lenney, North Staffs Hospital, Stoke on Trent; S Mackenzie, Royal London Hospital, London; J Y Paton and N Gibson, Royal Hospital for Sick Children Yorkhill, Glasgow; R Primak and M Everard, Children's Hospital, Sheffield; P Seddon, Royal Alexandra Children's Hospital, Brighton; R Smyth, Royal Liverpool Children's NHS Trust, Alder Hey, Liverpool.

Correspondence to:
Correspondence to:
Dr A H Thomson, Department of Paediatrics, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK;
anne.thomson{at}orh.nhs.uk

Background: The role of intrapleural fibrinolytic agents in the treatment of childhood empyema has not been established. A randomised double blind placebo controlled trial of intrapleural urokinase was performed in children with parapneumonic empyema.

Methods: Sixty children (median age 3.3 years) were recruited from 10 centres and randomised to receive either intrapleural urokinase 40 000 units in 40 ml or saline 12 hourly for 3 days. The primary outcome measure was length of hospital stay after entry to the trial.

Results: Treatment with urokinase resulted in a significantly shorter hospital stay (7.4 v 9.5 days; ratio of geometric means 1.28, CI 1.16 to 1.41 p=0.027). A post hoc analysis showed that the use of small percutaneous drains was also associated with shorter hospital stay. Children treated with a combination of urokinase and a small drain had the shortest stay (6.0 days, CI 4.6 to 7.8).

Conclusion: Intrapleural urokinase is effective in treating empyema in children and significantly shortens hospital stay.

Keywords: urokinase; children; empyema

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Gupta, A, Urquhart, D S, Devaraj, A, Balfour-Lynn, I M (2009). A 2 year old with fever and cough. BMJ 339: b2150-b2150 [Full Text]  
• Zabrocki, L. (2008). Early Thoracoscopy Leads to Shorter Length of Stay for Pneumonia Complicated by Pleural Effusion. AAP Grand Rounds 20: 42-43 [Full Text]  
• Jaffe, A, Calder, A D, Owens, C M, Stanojevic, S, Sonnappa, S (2008). Role of routine computed tomography in paediatric pleural empyema. Thorax 63: 897-902 [Abstract] [Full Text]  
• Cohen, E., Weinstein, M., Fisman, D. N. (2008). Cost-effectiveness of Competing Strategies for the Treatment of Pediatric Empyema. Pediatrics 121: e1250-e1257 [Abstract] [Full Text]  
• Kerek, O, Hilliard, T, Henderson, J (2008). WHAT IS THE BEST TREATMENT FOR EMPYEMA?. Arch. Dis. Child. 93: 173-174 [Full Text]  
• Li, S.-T. T., Gates, R. L. (2008). Primary Operative Management for Pediatric Empyema: Decreases in Hospital Length of Stay and Charges in a National Sample. Arch Pediatr Adolesc Med 162: 44-48 [Abstract] [Full Text]  
• Bush, A. (2007). Update in Pediatric Lung Disease 2006. Am. J. Respir. Crit. Care Med. 175: 532-540 [Full Text]  
• Dikensoy, O., Light, R. W. (2007). Diagnosing Empyema in Children. Am. J. Respir. Crit. Care Med. 175: 94a-95 [Full Text]  
• Kurt, B. A., Winterhalter, K. M., Connors, R. H., Betz, B. W., Winters, J. W. (2006). Therapy of Parapneumonic Effusions in Children: Video-Assisted Thoracoscopic Surgery Versus Conventional Thoracostomy Drainage. Pediatrics 118: e547-e553 [Abstract] [Full Text]  
• Mattei, P., Allen, J. L. (2006). Treatment of Empyema in Children: From Hippocrates' Time to the Present, and Back Again. Am. J. Respir. Crit. Care Med. 174: 110-111 [Full Text]  
• Sonnappa, S., Cohen, G., Owens, C. M., van Doorn, C., Cairns, J., Stanojevic, S., Elliott, M. J., Jaffe, A. (2006). Comparison of Urokinase and Video-assisted Thoracoscopic Surgery for Treatment of Childhood Empyema. Am. J. Respir. Crit. Care Med. 174: 221-227 [Abstract] [Full Text]  
• Roseby, R. (2006). Primary Operative Versus Nonoperative Therapy for Pediatric Empyema. Pediatrics 117: 1462-1463 [Full Text]  
• Medford, A, Maskell, N (2005). Pleural effusion. Postgrad. Med. J. 81: 702-710 [Abstract] [Full Text]  
• Bush, A (2005). How has research in the last five years changed my clinical practice?. Arch. Dis. Child. 90: 832-836 [Abstract] [Full Text]  
• Avansino, J. R., Goldman, B., Sawin, R. S., Flum, D. R. (2005). Primary Operative Versus Nonoperative Therapy for Pediatric Empyema: A Meta-analysis. Pediatrics 115: 1652-1659 [Abstract] [Full Text]  
• Maskell, N. A., Davies, C. W.H., Nunn, A. J., Hedley, E. L., Gleeson, F. V., Miller, R., Gabe, R., Rees, G. L., Peto, T. E.A., Woodhead, M. A., Lane, D. J., Darbyshire, J. H., Davies, R. J.O., the First Multicenter Intrapleural Sepsis Trial (M, (2005). U.K. Controlled Trial of Intrapleural Streptokinase for Pleural Infection. NEJM 352: 865-874 [Abstract] [Full Text]  
• Balfour-Lynn, I M (2005). Some consensus but little evidence: guidelines on management of pleural infection in children. Thorax 60: 94-96 [Full Text]  
• Balfour-Lynn, I M, Abrahamson, E, Cohen, G, Hartley, J, King, S, Parikh, D, Spencer, D, Thomson, A H, Urquhart, D, on behalf of the Paediatric Pleural Diseases Subco, (2005). BTS guidelines for the management of pleural infection in children. Thorax 60: i1-i21 [Full Text]  
• Saglani, S, Harris, K A, Wallis, C, Hartley, J C (2005). Empyema: the use of broad range 16S rDNA PCR for pathogen detection. Arch. Dis. Child. 90: 70-73 [Abstract] [Full Text]  
• Ekingen, G., Guvenc, B. H., Sozubir, S., Tuzlaci, A., Senel, U. (2004). Fibrinolytic treatment of complicated pediatric thoracic empyemas with intrapleural streptokinase. Eur. J. Cardiothorac. Surg. 26: 503-507 [Abstract] [Full Text]  
• Ozcelik, C., Ulku, R., Onat, S., Ozcelik, Z., Inci, I., Satici, O. (2004). Management of postpneumonic empyemas in children. Eur. J. Cardiothorac. Surg. 25: 1072-1078 [Abstract] [Full Text]  
• Schultz, K. D., Fan, L. L., Pinsky, J., Ochoa, L., Smith, E. O., Kaplan, S. L., Brandt, M. L. (2004). The Changing Face of Pleural Empyemas in Children: Epidemiology and Management. Pediatrics 113: 1735-1740 [Abstract] [Full Text]  
• Weinstein, M., Restrepo, R., Chait, P. G., Connolly, B., Temple, M., Macarthur, C. (2004). Effectiveness and Safety of Tissue Plasminogen Activator in the Management of Complicated Parapneumonic Effusions. Pediatrics 113: e182-185 [Abstract] [Full Text]  
• Yao, C.-T., Wu, J.-M., Liu, C.-C., Wu, M.-H., Chuang, H.-Y., Wang, J.-N. (2004). Treatment of Complicated Parapneumonic Pleural Effusion With Intrapleural Streptokinase in Children. Chest 125: 566-571 [Abstract] [Full Text]  
• Baranwal, A K, Singh, M, Marwaha, R K, Kumar, L (2003). Empyema thoracis: a 10-year comparative review of hospitalised children from south Asia. Arch. Dis. Child. 88: 1009-1014 [Abstract] [Full Text]  
• Jaffe, A, Cohen, G (2003). Thoracic empyema. Arch. Dis. Child. 88: 839-841 [Full Text]  
• Hilliard, T N, Henderson, A J, Hewer, S C L. (2003). Management of parapneumonic effusion and empyema. Arch. Dis. Child. 88: 915-917 [Abstract] [Full Text]  
• Satish, B, Bunker, M, Seddon, P (2003). Management of thoracic empyema in childhood: does the pleural thickening matter?. Arch. Dis. Child. 88: 918-921 [Abstract] [Full Text]  
• Davies, C W H, Gleeson, F V, Davies, R J O (2003). BTS guidelines for the management of pleural infection. Thorax 58: ii18-28 [Full Text]  
• Moss, S, Furness, J (2003). Time for a randomised controlled trial of empyema treatment?. Arch. Dis. Child. 88: 273-273 [Full Text]  
• Cohen, G., Hjortdal, V., Ricci, M., Jaffe, A., Wallis, C., Dinwiddie, R., Elliott, M. J., de Leval, M. R. (2003). Primary thoracoscopic treatment of empyema in children. J. Thorac. Cardiovasc. Surg. 125: 79-84 [Abstract] [Full Text]  
• Sit, S C, Cohen, G, Jaffe, A, Thomson, A H, Hull, J (2003). Urokinase in the treatment of childhood empyema. Thorax 58: 93-94 [Full Text]  
• Marcovitch, H. (2002). Atoms. Arch. Dis. Child. 87: 267-267 [Full Text]