Transitioning paediatric empyema management: Comparative efficacy analysis of tPA and DNase versus surgical interventions.

INTRODUCTION

Empyema significantly impacts paediatric morbidity and imposes a financial burden on healthcare systems. This study evaluates the efficacy of tissue plasminogen activator (tPA) and dornase alpha (DNase) combination in fibrinolytic therapy compared with surgical interventions (VATS/thoracotomy) in children with empyema.

MATERIALS AND

METHODS

A retrospective cohort consisted of 87 consecutive patients from January 2018 to December 2024, of whom 43 underwent surgical treatment and 44 received tPA + DNase therapy. The fibrinolytics group was divided into two subgroups to assess the learning curve: initial period (n = 22) and latest period (n = 22). The primary outcome was the hospitalisation duration. The secondary outcome measures included intensive care unit (ICU) admission rate, reintervention rate, costs of treatment, and empyema relapse within 30 days.

RESULTS

The median age was 3.9 years (range 0.7-17.3). The median duration of hospitalisation was 11 [9-14] days in VATS/thoracotomy group and 10 [7-13] days in fibrinolytics group (p = 0.086). The ICU admission rate was significantly lower in the fibrinolytics group (34.8 % vs. 13.6 %, p = 0.019), as were the costs of treatment (€32,628 [€25,386 - €44,504] vs €27,523 [€19,264 - €34,662], p = 0.011). Two empyema relapses were observed in each group. No readmissions occurred. The fibrinolytics group demonstrated higher reintervention rate compared to VATS/thoracotomy group (22.7 % vs. 7.0 %, p = 0.038) but significantly decreased in the latest period compared to the initial period (9.1 % vs. 36.0 %, p = 0.034), indicating a clear learning curve.

CONCLUSION

tPA + DNase therapy is a safe and effective management option for paediatric empyema.