Streptokinase Fibrinolysis Protocol: The Advantages of a Non-Operative Treatment for Stage II Pediatric Empyema Patients

Background: Pediatric empyema necessitates prompt resolution and early hospital discharge with minimal morbidity. However, the most effective treatment approach is not yet established. Objectives: To assess the efficacy of an intrapleural streptokinase washing protocol as a non-operative treatment for stage II pediatric empyema as compared to operative decortications, by the number of pediatric intensive care unit (PICU) admissions, length of PICU stay, and hospitalization duration. Methods: We retrospectively evaluated 75 consecutive pediatric empyema cases for the period January 2006 to December 2009, Since July 2007 we have used repeated streptokinase-based pleural washing for stage II patients whose condition did not improve with chest drainage. Results: Before July 2007, 17 of 23 stage II empyema patients underwent decortication, compared to only 1 of 21 after July 2007. Non-operated children were admitted to the PICU less frequently than those who were operated (83% vs. 31%, P = 0.0006) and spent less time in the PICU (2.56 +/- 1.92 vs. 1.04 +/- 1.9 days, P = 0.0148); there was no significant statistical difference in overall hospitalization (13.33 +/- 3.69 vs. 11.70 +/- 5.74 days, P = 0.301). Conclusions: Using intrapleural streptokinase washing as a non-operative treatment for stage II pediatric empyema yielded comparable success rates to the operative approach, with less morbidity.