Department of Surgery, Children's Mercy Hospital, 2401, Gillham Road, Kansas City, MO, 64108, USA.
Department of Health Services and Outcomes Research, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA.
Pediatr Surg Int. 2024 Nov 4;40(1):289. doi: 10.1007/s00383-024-05868-w.
This study seeks to investigate the contemporary use and effectiveness of fibrinolysis as a first-line option in pediatric empyema.
The Pediatric Health Information System (PHIS) was queried to identify patients with empyema without fistula (2018-2023). First-line treatments were chest drainage (CD), chest drainage with fibrinolysis (CDF), and video-assisted thoracoscopic surgery/open decortication (VATS/OD). Outcomes between groups were compared using Kruskal-Wallis and Chi-Square tests. Multivariate generalized linear model was used to account for covariates.
581 individuals/cases met inclusion criteria. CD accounted for 11.9% of cases, CDF for 67.6%, and VATS/OD for 20.7%. After adjusting for covariates differences in LOS were not significant (p = 0.393). Subsequent VATS/ODs were required in 6.9% of CDF cases, 8.9% of CD, and 3.3% of primary VATS/OD. Additionally, 32.5% of primary VATS/OD received adjuvant fibrinolysis. Complications were more often observed in the VATS/OD group compared to CD and CDF (11.7% vs 5.8% and 4.1% respectively; p = .008). There were no differences in 30-day readmission rate (VATS/OD:1.2%, CTD:1.5%, and CTDF:1%; p = 0.83).
Fibrinolysis is now utilized as first-line treatment for most patients and as adjunct in other approaches. The findings justify further implementation as it is the less invasive first-line primary therapy in patients with empyema.
本研究旨在探讨纤溶治疗在小儿脓胸中的当代应用和疗效，作为一线选择。
通过小儿健康信息系统（PHIS）查询无瘘管脓胸患者（2018-2023 年）。一线治疗包括胸腔引流（CD）、胸腔引流联合纤溶（CDF）和电视辅助胸腔镜手术/开放去皮质（VATS/OD）。使用 Kruskal-Wallis 和卡方检验比较组间结局。采用多变量广义线性模型来校正协变量。
581 名患者符合纳入标准。CD 占 11.9%，CDF 占 67.6%，VATS/OD 占 20.7%。校正协变量后， LOS 差异无统计学意义（p=0.393）。CDF 后需行 VATS/OD 的比例为 6.9%，CD 为 8.9%，VATS/OD 为 3.3%。此外，32.5%的 VATS/OD 患者接受了辅助纤溶治疗。VATS/OD 组并发症发生率高于 CD 和 CDF 组（分别为 11.7%、5.8%和 4.1%；p=0.008）。30 天再入院率无差异（VATS/OD：1.2%，CDT：1.5%，CDTF：1%；p=0.83）。
纤溶治疗目前作为大多数患者的一线治疗方法，并作为其他方法的辅助治疗。这一发现证明了进一步实施纤溶治疗的合理性，因为它是脓胸患者更具侵袭性的一线原发性治疗方法。
