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


CONCLUSIONS
Intrapleural urokinase is effective in treating empyema in children and significantly shortens hospital stay.
Thomson
A H
AH
Department of Paediatrics, John Radcliffe Hospital, Oxford, UK. anne.thomson@orh.nhs.uk
Hull
J
J
Kumar
M R
MR
Wallis
C
C
Balfour Lynn
I M
IM
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004653:Empyema / Q000188:drug therapy*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007902:Length of Stay; D010960:Plasminogen Activators / Q000627:therapeutic use*; D012044:Regression Analysis; D016019:Survival Analysis; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*
D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator