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Randomised trial of intrapleural urokinase in the treatment of childhood empyema.

Author(s): Thomson AH, Hull J, Kumar MR, Wallis C, Balfour Lynn IM

Affiliation(s): Department of Paediatrics, John Radcliffe Hospital, Oxford, UK. anne.thomson@orh.nhs.uk

Publication date & source: 2002-04, Thorax., 57(4):343-7.

Publication type: Clinical Trial; Multicenter Study; Randomized Controlled Trial

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.

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