After testing the two most common treatments for empyema in children and seeing equal clinical results, researchers concluded that the enzyme urokinase should be the primary treatment against infection in the lung lining because it costs 25 percent less than the other procedure, video-assisted thoracoscopic surgery.
The study results appear in the second issue for July 2006 of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.
Samatha Sonnappa, M.D., of the Portex Respiratory Unit at the Institute of Child Health in London, and seven associates studied 60 children with empyema, which involves pus from pneumonia infecting the pleural membrane lining the lung walls. Thirty children were treated with chest drainage using intrapleural urokinase, and 30 underwent video-assisted thorascopic surgery for the problem. The average age of the patients was 3-1/2.
The pleura is a very thin, transparent membrane that covers the lungs and lines the inside of the chest wall. Empyema occurs when pus from pneumonia or a lung abscess spreads into the pleural space. About 0.6 percent of childhood pneumonia progresses to empyema.
"The aim of treatment in empyema is to sterilize the pleural cavity, reduce fever and ensure the full expansion of the lung so it can return to normal function," said Dr. Sonnappa. "Our study is the first randomized prospective trial to compare chest drain against primary video-assisted thorascopic surgery for the treatment of empyema in children."
No significant clinical differences were found between each treatment group in terms of length of hospital stay after intervention, failure rate of the procedure or radiologic outcome at 6 months after the procedure.
"An important observation is that video-assisted thorascopic surgery is $2,250 or 25 percent more expensive than intrapleural urokinase at our center without including start-up costs for the provision of surgery," said Dr. Sonnappa. "Also, a major limitation of the surgical procedure is that it is highly dependent on the skill of the operator. Poor results in some centers have been reported, and surgical expertise to perform pediatric video-assisted thorascopic surgery is limited to a few major centers in the United Kingdom."
The researchers estimated that in 2005, the number of pneumonia cases that progressed to empyema was approximately 6,600 in the U.S. and 1,080 in the U.K. If intrapleural urokinase was used as the first line of treatment for pediatric empyema in each of these cases, it would have resulted in a health care savings of $15 million in the U.S., and $2.5 million in the U.K.
