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Chest Drain is Best Treatment for Childhood Empyema

Researchers find it as effective, less costly than video-assisted thoracoscopic surgery

FRIDAY, July 14 (HealthDay News) -- In the treatment of childhood empyema, chest drain with intrapleural urokinase is as effective and more cost-effective than video-assisted thoracoscopic surgery (VATS), according to a study published in the July 15 issue of the American Journal of Respiratory and Critical Care Medicine.

Samatha Sonnappa, M.D, of the Institute of Child Health in London, U.K., and colleagues studied 60 children who were randomized to receive either percutaneous chest drain with intrapleural urokinase or primary VATS.

The researchers found no significant group differences in the median length of hospital stay (six days for urokinase versus six days for VATS), total hospital stay (seven days for urokinase versus eight days for VATs), or in the failure rate or radiological outcome. They also found that the median treatment costs were $6,914 for urokinase versus $10,146 for VATS.

"The study by Sonnappa and colleagues is clearly a helpful step in the direction of providing needed insight into the management of pleural infection in children," state the authors of an accompanying editorial. "Recently, clinical pathways have been suggested that emphasize individual patient assessment and staging, with prompt treatment and escalation of therapy in non-responders. We favor this approach. Local expertise is an important consideration, and studies that will identify those patients who would benefit from initial surgical therapy are still needed."

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