Comparing Treatment Modalities For Parapneumonic Pleural Empyema In Children: What To Choose And When, A Retrospective Study

Introduction: Parapneumonic pleural empyema (PPE) is common in children, however, the most appropriate treatment is not established. We aimed to analyse and compare treatments for PPE and its outcomes. Methods: Single-centre retrospective analysis of PPE cases from 2012-2024, concerning demographics, times until treatment and resolution, failure, alternative treatments, complications and follow-up. Lung necrosis contraindicated fibrinolysis; simple effusions and bilateral pneumonias were excluded. Time until treatment was considered after the diagnosis of PPE. Results: 77 cases were identified with a median age of 5 years. The most common initial treatment was intrapleural fibrinolysis (58%), followed by thoracoscopic decortication (29%) and simple drainage (13%). Failure happened after all (10/10) drainages, 22% (10/45) of fibrinolysis and 9% (2/22) of thoracoscopies. Compared to thoracoscopy, fibrinolysis had no difference in failure (p=0.310) but had a longer treatment duration (17 versus 13 days, p=0.004). Excluding failures, no difference was found in treatment duration, postoperative fever and complications. Conclusion: While simple drainage of PPE should not be attempted, thoracoscopic decortication and fibrinolysis seem equally effective. There was a shorter treatment duration with thoracoscopic decortication and no increase in complications, so the authors recommend it should be employed promptly when fibrinolysis is contraindicated, as in necrotizing pneumonia.