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
- 1John Radcliffe Hospital, Oxford, UK
- 2Great Ormond Street Hospital, London, UK
- 3Royal Brompton and Harefield NHS Trust, London, UK
- 4Members 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:
Dr A H Thomson, Department of Paediatrics, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK;
- Accepted 1 November 2001
- Revised 24 September 2001
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.
This study was funded by individual charitable funds at each centre and the NHS R and D levy.
Conflicts of interest: none.