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Context <p>Although intrapleural fibrinolytic therapy (IPFT) is frequently used in empyema thoracis, there is lack of clarity regarding the ideal timing of its administration.</p> Objective <p>To synthesize evidence comparing early IPFT (i.e. at presentation, or as early as feasible, but within 24&#xa0;h of confirmation of empyema), versus late(r) instillation (i.e. after 24&#xa0;h of confirmation of empyema) in children with empyema, for the purpose of framing an evidence-based guideline recommendation.</p> Evidence Acquisition <p>We searched for randomized controlled trials (RCTs) comparing early versus late(r) IPFT in children (&lt; 18y) with confirmed empyema, through five databases of published literature viz. PubMed, EMBASE, the Cochrane Library, Web of Science (WOS), and Scopus, two grey literature databases (ProQuest and OpenGrey), and four clinical trial registries. There were no restrictions&#xa0;or filters used. A three-step approach was implemented to screen and select studies eligible for inclusion. The patient-centric outcomes evaluated were indicators of treatment failure, clinical outcomes, pulmonary function tests, adverse events and cost of therapy. We planned to calculate pooled odds ratios (OR), and mean differences (MDs) with 95% confidence intervals (CIs) for dichotomous and continuous outcomes respectively. The certainty of evidence was to be assessed using the GRADE approach.</p> Results <p>The comprehensive search identified 3,110 citations, however there was no RCT addressing the review question.</p> Conclusions <p>There are no RCTs comparing early versus late(r) use of fibrinolytic therapy in childhood empyema. Well-designed randomized controlled trials are required to address the question. Evidence-based guidance on the question must use additional considerations, until RCT evidence is available.</p> Trial Registration <p>The protocol of the systematic review was registered in the PROSPERO database (ID: CRD42024516041) on March 03, 2024.</p>

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Early Versus Late(r) Administration of Intrapleural Fibrinolytic Therapy in Children with Empyema: A Systematic Review and Meta-Analysis

  • 期刊论文

  • 发表日期：

    2026年7月10日

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  • Davinder Kaur,
  • Ketan Kumar,
  • Pravakar Mishra,
  • Narayan Santuka,
  • Anshula Tayal,
  • Pranita Pradhan,
  • Joseph L. Mathew

摘要

Context

Although intrapleural fibrinolytic therapy (IPFT) is frequently used in empyema thoracis, there is lack of clarity regarding the ideal timing of its administration.

Objective

To synthesize evidence comparing early IPFT (i.e. at presentation, or as early as feasible, but within 24 h of confirmation of empyema), versus late(r) instillation (i.e. after 24 h of confirmation of empyema) in children with empyema, for the purpose of framing an evidence-based guideline recommendation.

Evidence Acquisition

We searched for randomized controlled trials (RCTs) comparing early versus late(r) IPFT in children (< 18y) with confirmed empyema, through five databases of published literature viz. PubMed, EMBASE, the Cochrane Library, Web of Science (WOS), and Scopus, two grey literature databases (ProQuest and OpenGrey), and four clinical trial registries. There were no restrictions or filters used. A three-step approach was implemented to screen and select studies eligible for inclusion. The patient-centric outcomes evaluated were indicators of treatment failure, clinical outcomes, pulmonary function tests, adverse events and cost of therapy. We planned to calculate pooled odds ratios (OR), and mean differences (MDs) with 95% confidence intervals (CIs) for dichotomous and continuous outcomes respectively. The certainty of evidence was to be assessed using the GRADE approach.

Results

The comprehensive search identified 3,110 citations, however there was no RCT addressing the review question.

Conclusions

There are no RCTs comparing early versus late(r) use of fibrinolytic therapy in childhood empyema. Well-designed randomized controlled trials are required to address the question. Evidence-based guidance on the question must use additional considerations, until RCT evidence is available.

Trial Registration

The protocol of the systematic review was registered in the PROSPERO database (ID: CRD42024516041) on March 03, 2024.