Sonnappa S, Cohen G, Owens CM, et al. Comparison of urokinase and video-assisted thoracoscopic surgery for treatment of childhood empyema. Am J Respir Crit Care Med. 2006;174:221–7.

Article  PubMed  Google Scholar 

Marhuenda C, Barceló C, Fuentes I, et al. Urokinase versus VATS for treatment of empyema: a randomized multicenter clinical trial. Pediatrics. 2014;134:e1301–7.

Article  PubMed  Google Scholar 

Livingston MH, Mahant S, Ratjen F, et al. Intrapleural dornase and tissue plasminogen activator in pediatric empyema (DTPA): a study protocol for a randomized controlled trial. Trials. 2017;18:293.

Article  PubMed  PubMed Central  Google Scholar 

de Benedictis FM, Kerem E, Chang AB, et al. Complicated pneumonia in children. Lancet. 2020;396:786–98.

Article  PubMed  Google Scholar 

Redden MD, Chin TY, van Driel ML. Surgical versus non-surgical management for pleural empyema. Cochrane Database Syst Rev. 2017;3:CD010651.

PubMed  PubMed Central  Google Scholar 

Pacilli M, Nataraja RM. Management of paediatric empyema by video-assisted thoracoscopic surgery (VATS) versus chest drain with fibrinolysis: Systematic review and meta-analysis. Paediatr Respir Rev. 2019;30:42–8.

PubMed  Google Scholar 

Rahman NM, Maskell NA, West A, et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med. 2011;365:518–26.

Article  CAS  PubMed  Google Scholar 

Balfour-Lynn I, Abrahamson E, Cohen G, et al. BTS Guidelines for the Management of Pleural Infection in Children. Thorax. 2005;60:i1–21.

Article  PubMed  PubMed Central  Google Scholar 

Strachan RE, Jaffé A, Thoracic Society of Australia and New Zealand. Recommendations for managing paediatric empyema thoracis. Med J Aust. 2011;195:95.

Article  PubMed  Google Scholar 

Islam S, Calkins CM, Goldin AB, et al. The diagnosis and management of empyema in children: a comprehensive review from the APSA outcomes and clinical trials committee. J Pediatr Surg. 2012;47:2101–10.

Article  PubMed  Google Scholar 

Bradley JS, Byington CL, Shah SS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53:e25-76.

Article  PubMed  PubMed Central  Google Scholar 

Scarci M, Abah U, Solli P, et al. EACTS expert consensus statement for surgical management of pleural empyema. Eur J Cardiothorac Surg. 2015;48:642–53.

Article  PubMed  Google Scholar 

Chibuk T, Cohen E, Robinson J, et al. Paediatric complicated pneumonia: diagnosis and management of empyema. Paediatr Child Health. 2011;16:425–7.

PubMed  PubMed Central  Google Scholar 

Purohit A, Pradhan P, Mittal H, et al. Intrapleural fibrinolytic therapy compared to video-assisted thoracoscopic surgery, as the initial treatment modality, in children with empyema: A systematic review and meta-analysis. Accessed 16 May 2024. Available from: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024517174

Higgins JPT, Thomas J, Chandler J, et al. Cochrane Handbook for Systematic Reviews of Interventions version 6.5. Cochrane, 2024. Accessed 1 April 2025. Available from: www.cochrane.org/handbook

Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.

Article  PubMed  PubMed Central  Google Scholar 

Singh M, Singh SK, Chowdhary SK. Management of empyema thoracic in children. Indian Pediatr. 2002;39:145–57.

PubMed  Google Scholar 

Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898.

Article  PubMed  Google Scholar 

Schünemann H, Brożek J, Guyatt G, Oxman A, editors. GRADE handbook for grading quality of evidence and strength of recommendations. The GRADE Working Group; 2013.

Google Scholar 

Review Manager (RevMan) [computer program]. Version 10. The Cochrane Collaboration; 2024. Accessed 6 April 2025. Available from: https://revman.cochrane.org/

Lim TK, Chin NK. Empirical treatment with fibrinolysis and early surgery reduces the duration of hospitalization in pleural sepsis. Eur Respir J. 1999;13:514–8.

Article  CAS  PubMed  Google Scholar 

Margenthaler JA, Weber TR, Keller MS. Predictors of surgical outcome for complicated pneumonia in children: impact of bacterial virulence. World J Surg. 2004;28:87–91.

Article  PubMed  Google Scholar 

Muhammad MIA. Management of complicated parapneumonic effusion and empyema using different treatment modalities. Asian Cardiovasc Thorac Ann. 2012;20:177–81.

Article  PubMed  Google Scholar 

Suárez PR, Gilart JF, Pérez JMH, et al. Treatment of complicated parapneumonic pleural effusion and pleural parapneumonic empyema. Med Sci Monit Int Med J Exp Clin Res. 2012;18:CR443–9.

Google Scholar 

Bell ACJ, Baker C, Duret A. Is chest drain insertion and fibrinolysis therapy equivalent to video-assisted thoracoscopic surgery to treat children with parapneumonic effusions? Arch Dis Child. 2023;108:940–2.

Article  PubMed  Google Scholar 

Course CW, Hanks R, Doull I. Question 1 what is the best treatment option for empyema requiring drainage in children? Arch Dis Child. 2017;102:588–90.

Article  PubMed  Google Scholar 

Foster AB, Park F, Hyett J. Do first-trimester screening algorithms for preeclampsia aligned to use of preventative therapies reduce the prevalence of pre-term preeclampsia: a systematic review and meta-analysis. Prenat Diagn. 2023;43:950–8.

Article  PubMed  Google Scholar 

Cohen E, Weinstein M, Fisman DN. Cost-effectiveness of competing strategies for the treatment of pediatric empyema. Pediatrics. 2008;121:e1250–7.

Article  PubMed  Google Scholar 

Fernandez Elviro C, Longcroft-Harris B, Allin E, et al. Conservative and surgical modalities in the management of pediatric parapneumonic effusion and empyema: a living systematic review and network meta-analysis. Chest. 2023;164:1125–38.

Article  PubMed  Google Scholar 

St Peter SD, Tsao K, Spilde TL, et al. Thoracoscopic decortication vs tube thoracostomy with fibrinolysis for empyema in children: a prospective, randomized trial. J Pediatr Surg. 2009;44:106–11 (discussion 111).

Article  PubMed  PubMed Central  Google Scholar 

Cobanoglu U, Sayir F, Bilici S, et al. Comparison of the methods of fibrinolysis by tube thoracostomy and thoracoscopic decortication in children with stage II and III empyema: a prospective randomized study. Pediatr Rep. 2011;3:e29.

Article  PubMed  PubMed Central  Google Scholar 

Shankar G, Sahadev R, Santhanakrishnan R. Pediatric empyema thoracis management: should the consensus be different for the developing countries? J Pediatr Surg. 2020;55:513–7.

Article  PubMed  Google Scholar 

Coote N, Kay E. Surgical versus non-surgical management of pleural empyema. Cochrane Database Syst Rev. 2005;4:CD001956.

Google Scholar 

Miscia ME, Lauriti G, Di Renzo D, Cascini V, Lisi G. Video-assisted thoracoscopic surgery versus tube thoracostomy with fibrinolytics for treatment of empyema in children: a meta-analysis of randomized controlled studies. Children (Basel). 2025;12:1225.

PubMed  PubMed Central  Google Scholar 

Omid M, Rafieezadeh A, Talebi Anaraki K, et al. Comparing the efficacy of video assisted thoracoscopic surgery (VATS) vs intrapleural fibrinolytic therapy in children with pleural empyema. Pediatr Surg Int. 2025;41:111.

Article  PubMed  Google Scholar 

Jakkal VD, Nagdeve N, Jakkal DP. Comparative study of chest tube drainage with intrapleural urokinase versus thoracoscopic drainage for fibropurulent empyema in pediatric age group. J Cardiovasc Dis Res. 2024;15:2026–35.

Google Scholar 

Shipe ME, Maiga AW, Deppen SA, et al. Cost-effectiveness analysis of fibrinolysis vs thoracoscopic decortication for early empyema. Ann Thorac Surg. 2021;112:1632–8.

Article  PubMed  Google Scholar