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Thorax 57:343-347 doi:10.1136/thorax.57.4.343
  • Original articles

Randomised trial of intrapleural urokinase in the treatment of childhood empyema

  1. A H Thomson1,
  2. J Hull1,
  3. M R Kumar1,
  4. C Wallis2,
  5. I M Balfour Lynn3,
  6. On Behalf Of The British Paediatric Respiratory Society Empyema Study Group4
  1. 1John Radcliffe Hospital, Oxford, UK
  2. 2Great Ormond Street Hospital, London, UK
  3. 3Royal Brompton and Harefield NHS Trust, London, UK
  4. 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.
  1. Correspondence to:
    Dr A H Thomson, Department of Paediatrics, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK;
    anne.thomson{at}orh.nhs.uk
  • Accepted 1 November 2001
  • Revised 24 September 2001

Abstract

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.

Footnotes

  • This study was funded by individual charitable funds at each centre and the NHS R and D levy.

  • Conflicts of interest: none.