{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T04:41:41Z","timestamp":1792212101465,"version":"4.4.0"},"reference-count":45,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Paediatrics Child Health"],"abstract":"ABSTRACT<\/jats:title>\n \n Aim<\/jats:title>\n To examine and compare management strategies for paediatric pleural empyema with respect to efficacy, safety, length of hospital stays, complications and long\u2010term outcomes.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Database searches across PubMed, Web of Science, Cochrane Library and ScienceDirect (January 2005\u2013May 2025) were conducted following PRISMA guidelines. After exclusions, 22 studies (RCTs and observational) were included. Quality was assessed using the Newcastle\u2010Ottawa Scale and Cochrane Risk of Bias tool. Because studies defined success inconsistently, effectiveness was also expressed as single\u2010procedure success: resolution without a further drainage procedure. Other outcomes included reintervention, hospital stay, complications and mortality.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Included were 18 cohort studies and 4 RCTs (3667 patients; empyema stages 1\u20133). Evaluated approaches included video\u2010assisted thoracic surgery (VATS), intrapleural fibrinolysis, chest tube drainage and thoracotomy. Study\u2010reported success ranged from 90%\u201396% with VATS and 70%\u201395% with fibrinolysis; expressed as single\u2010procedure success, these fell to 67%\u2013100% and 63%\u201398%, respectively, against 47% for drainage alone. Chest tube duration was often shorter after VATS, although the drain serves a different purpose in each pathway and is not a measure of efficacy. Overall complication rates were low; bronchopleural fistula was reported by only three studies.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Both VATS and intrapleural fibrinolysis are safe and effective treatments for paediatric empyema. Both are superior to chest drainage alone. VATS more often achieves resolution with a single procedure, whereas fibrinolysis remains a viable, less\u2010invasive first\u2010line option. Simple parapneumonic effusion requires intravenous antibiotics and supportive care alone. Because allocation was not standardized, differences in reintervention should not be read causally.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/jpc.70617","type":"journal-article","created":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T03:57:39Z","timestamp":1792209459000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Management Strategies for Paediatric Pleural Empyema: A Systematic Review"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-4763-8764","authenticated-orcid":false,"given":"Atheer I.","family":"Shahar","sequence":"first","affiliation":[{"name":"Pediatric Pulmonology Division, Department of Pediatrics Security Forces Hospital Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8682-6080","authenticated-orcid":false,"given":"Maryam Mohammed","family":"Alghamdi","sequence":"additional","affiliation":[{"name":"Pediatric Pulmonology Division, Department of Pediatrics Prince Sultan Military Medical City Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9142-7470","authenticated-orcid":false,"given":"Zainab Ahmed","family":"Athwani","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Jazan General Hospital Jazan Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3931-1056","authenticated-orcid":false,"given":"Lama Hassan","family":"Ayoub","sequence":"additional","affiliation":[{"name":"Pediatric Allergy and Immunology Division, Department of Pediatrics King Fahad Medical City Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1731-4765","authenticated-orcid":false,"given":"Afraa Hashim","family":"Mutahar","sequence":"additional","affiliation":[{"name":"Department of Pediatrics King Faisal Specialist Hospital & Research Centre Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6667-1240","authenticated-orcid":false,"given":"Ayed Mohammed","family":"Alenazi","sequence":"additional","affiliation":[{"name":"Pediatric Pulmonology Division, Department of Pediatrics Prince Sultan Military Medical City Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4877-7305","authenticated-orcid":false,"given":"Alnashmi S.","family":"Alanazi","sequence":"additional","affiliation":[{"name":"Pediatric Pulmonology Division, Department of Pediatrics Security Forces Hospital Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"issue":"1","key":"e_1_2_12_2_1","doi-asserted-by":"crossref","first-page":"S29","DOI":"10.5606\/tgkdc.dergisi.2024.25759","article-title":"Empyema in Children","volume":"32","author":"Kuru M.","year":"2024","journal-title":"Turkish Journal of Thoracic and Cardiovascular Surgery"},{"issue":"5","key":"e_1_2_12_3_1","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1002\/ppul.24255","article-title":"Clinical, Functional, and Radiological Outcome in Children With Pleural Empyema","volume":"54","author":"Maffey A.","year":"2019","journal-title":"Pediatric Pulmonology"},{"issue":"5","key":"e_1_2_12_4_1","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1093\/clinids\/22.5.747","article-title":"Pleural Empyema","volume":"22","author":"Bryant R. 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