# Treatment outcomes in pediatric empyema: a retrospective observational study from a tertiary center in Dubai, United Arab Emirates

## TL;DR

This study compares treatments for pediatric empyema in Dubai and finds that using a drainage tube with a drug called alteplase is more effective than surgery or drainage alone.

## Contribution

The study provides real-world evidence on treatment effectiveness and identifies factors affecting hospital stays for pediatric empyema in the UAE.

## Key findings

- Intrapleural alteplase reduced hospital stays and surgical needs compared to drainage alone.
- Older age and use of multiple antibiotics correlated with longer hospital stays.
- No serious drug-related adverse events were observed with alteplase use.

## Abstract

To evaluate real-world effectiveness of intrapleural fibrinolysis versus drainage alone or surgery, and to identify factors linked to prolonged hospitalisation in children with pleural empyema at a tertiary centre. We also aimed to provide regional baseline data to guide future care.

We retrospectively reviewed records for all patients aged ≤ 14 years treated for pleural empyema et al. Jalila Children’s Specialty Hospital, Dubai, from January 2021 to December 2024. Demographics, imaging, treatments, antibiotic use, and in-hospital outcomes were abstracted and summarised descriptively.

Thirty-five children (median age 4 years; 54% female) were included. All underwent ultrasound-guided tube thoracostomy, and 30 (86%) also received intrapleural alteplase. Four children needed surgical decortication and 1 child with lymphoma died. Median tube drainage was 6 days with fibrinolysis versus 8 days without. Median hospital stay was 11 days with fibrinolysis, 27 days without, and 13.5 days after surgery. Hospitalisation ≥ 15 days correlated with older age, omission of fibrinolysis, use of ≥ 4 antibiotics, and computed tomography imaging. No serious drug-related adverse events occurred.

Prompt tube thoracostomy combined with intrapleural alteplase is a safe, effective, and resource-efficient first-line therapy for paediatric empyema, shortening hospital stay and markedly reducing the need for surgery.