Damir Ljuhar1, Jessica Rayner2, Ela Hyland3, Sebastian King2,4,5. 1. Department of Paediatrics, Monash University, Melbourne, Australia. damir.ljuhar@monash.edu. 2. Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Australia. 3. Department of Paediatric Surgery and Urology, Canberra Hospital, Canberra, Australia. 4. Surgical Research, Murdoch Children's Research Institute, Melbourne, Australia. 5. Department of Paediatrics, University of Melbourne, Melbourne, Australia.
Abstract
PURPOSE: To define the spectrum of management for thoracic empyema in children in Australia and New Zealand. METHODS: Online survey of members of the Australian and New Zealand Association of Paediatric Surgeons (ANZAPS), limited to consultant/attending paediatric surgeons. RESULTS: A total of 54/80 (67.5%) members, from 16 paediatric surgical centres, responded. The majority (33/54, 61%) preferred chest drain with fibrinolytics, whilst 21/54 (39%) preferred video-assisted thoracoscopic surgery (VATS) with drain insertion. Urokinase was the most commonly used fibrinolytic (64%). There were no significant differences in management preferences between practising surgeons in Australia and New Zealand (p = 0.54), nor between consultants who had been practising a shorter (< 5 years) or longer (> 20 years) amount of time (p = 0.21). The practices described by the surveyed ANZAPS members were in line with the Thoracic Society of Australia and New Zealand recommendations for the management of paediatric empyema. CONCLUSION: Across Australia and New Zealand there exists significant variation surrounding the intra- and post-intervention management of thoracic empyema in children. The surveyed paediatric surgeons demonstrated a preference for fibrinolytics over the use of VATS. All management regimens were within published local guidelines.
PURPOSE: To define the spectrum of management for thoracic empyema in children in Australia and New Zealand. METHODS: Online survey of members of the Australian and New Zealand Association of Paediatric Surgeons (ANZAPS), limited to consultant/attending paediatric surgeons. RESULTS: A total of 54/80 (67.5%) members, from 16 paediatric surgical centres, responded. The majority (33/54, 61%) preferred chest drain with fibrinolytics, whilst 21/54 (39%) preferred video-assisted thoracoscopic surgery (VATS) with drain insertion. Urokinase was the most commonly used fibrinolytic (64%). There were no significant differences in management preferences between practising surgeons in Australia and New Zealand (p = 0.54), nor between consultants who had been practising a shorter (< 5 years) or longer (> 20 years) amount of time (p = 0.21). The practices described by the surveyed ANZAPS members were in line with the Thoracic Society of Australia and New Zealand recommendations for the management of paediatric empyema. CONCLUSION: Across Australia and New Zealand there exists significant variation surrounding the intra- and post-intervention management of thoracic empyema in children. The surveyed paediatric surgeons demonstrated a preference for fibrinolytics over the use of VATS. All management regimens were within published local guidelines.
Authors: Roxanne Strachan; Nusrat Homaira; Sean Beggs; Mejbah U Bhuiyan; Gwendolyn L Gilbert; Stephen B Lambert; Kristine Macartney; Helen Marshall; Andrew C Martin; Gabrielle B McCallum; Angela McCullagh; Tim McDonald; Peter McIntyre; Shahin Oftadeh; Sarath Ranganathan; Sadasivam Suresh; Claire E Wainwright; Angela Wilson; Melanie Wong; Thomas Snelling; Adam Jaffé Journal: Thorax Date: 2021-01-27 Impact factor: 9.139
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