title: Urokinase versus VATS for treatment of empyema: a randomized multicenter clinical trial.
abstract: OBJECTIVE
  Parapneumonic empyema (PPE) is a frequent complication of acute bacterial pneumonia in children. There is limited evidence regarding the optimal treatment of this condition. The aim of this study was to compare the efficacy of drainage plus urokinase versus video-assisted thoracoscopic surgery in the treatment of PPE in childhood.
  
  
  METHODS
  This prospective, randomized, multicenter clinical trial enrolled patients aged <15 years and hospitalized with septated PPE. Study patients were randomized to receive urokinase or thoracoscopy. The main outcome variable was the length of hospital stay after treatment. The secondary outcomes were total length of hospital stay, number of days with the chest drain, number of days with fever, and treatment failures. The trial was approved by the ethics committees of all the participating hospitals.
  
  
  RESULTS
  A total of 103 patients were randomized to treatment and analyzed; 53 were treated with thoracoscopy and 50 with urokinase. There were no differences in demographic characteristics or in the main baseline characteristics between the 2 groups. No statistically significant differences were found between thoracoscopy and urokinase in the median postoperative stay (10 vs 9 days), median hospital stay (14 vs 13 days), or days febrile after treatment (4 vs 6 days). A second intervention was required in 15% of children in the thoracoscopy group versus 10% in the urokinase group (P = .47).
  
  
  CONCLUSIONS
  Drainage plus urokinase instillation is as effective as video-assisted thoracoscopic surgery as first-line treatment of septated PPE in children.
authors.affiliation: Departments of Pediatric Surgery, claudia.marhuenda@ssib.es.
authors.forename: Claudia
authors.initials: C
authors.lastname: Marhuenda
authors.affiliation: Departments of Pediatric Surgery.
authors.forename: Concepció
authors.initials: C
authors.lastname: Barceló
authors.affiliation: Clinical Pharmacology, and.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Fuentes
authors.affiliation: Departments of Pediatric Surgery.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Guillén
authors.affiliation: Department of Pediatric Surgery, Hospital 12 de Octubre, Madrid, Spain;
authors.forename: Indalecio
authors.initials: I
authors.lastname: Cano
authors.affiliation: Department of Pediatric Surgery, Hospital 12 de Octubre, Madrid, Spain;
authors.forename: María
authors.initials: M
authors.lastname: López
authors.affiliation: Department of Pediatric Surgery, Hospital La Paz, Madrid, Spain;
authors.forename: Francisco
authors.initials: F
authors.lastname: Hernández
authors.affiliation: Department of Pediatrics, University of the Basque Country, UPV/EHU, San Sebastian, Spain; Division of Pediatric Respiratory Medicine, Hospital Universitario Donostia-Instituto Biodonostia, San Sebastián, España; Biomedical Research Centre Network for Respiratory Diseases (CIBERES), San Sebastián, Spain;
authors.forename: Eduardo G
authors.initials: EG
authors.lastname: Pérez-Yarza
authors.affiliation: Department of Pediatric Surgery, Hospital Gregorio Marañón, Madrid, Spain; and.
authors.forename: José A
authors.initials: JA
authors.lastname: Matute
authors.affiliation: Department of Pediatric Surgery, Hospital Gregorio Marañón, Madrid, Spain; and.
authors.forename: María A
authors.initials: MA
authors.lastname: García-Casillas
authors.affiliation: Department of Pediatric Surgery, Hospital Central de Asturias, Oviedo, Spain.
authors.forename: Víctor
authors.initials: V
authors.lastname: Alvarez
authors.affiliation: Pediatric Pulmonology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona. Barcelona, Spain;
authors.forename: Antonio
authors.initials: A
authors.lastname: Moreno-Galdó
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016724:Empyema, Pleural / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D014568:Urokinase-Type Plasminogen Activator
keywords: VATS; children; empyema; fibrinolytics; parapneumonic effusions; randomized clinical trial; urokinase; video-assisted thoracoscopic surgery