Abstract：
The optimal treatment for community-acquired childhood pneumonia complicated by empyema remains unclear.
In children with parapneumonic effusion or empyema, do hospital length of stay and other key clinical outcomes differ according to the treatment modality used?
A living systematic review of randomized controlled trials (RCTs) was conducted by searching the Cochrane Central Register of Controlled Trials, Embase, Latin American and Caribbean Health Sciences Literature, Ovid MEDLINE, and Web of Science Core Collection databases. Eligible RCTs included patients aged < 18 years and compared two of the following treatment modalities: antibiotics alone, chest tube insertion with or without fibrinolytics, video-assisted thoracoscopic surgery (VATS), and decortication via thoracotomy. A network meta-analysis was performed to evaluate treatment effects on hospital length of stay (LOS), the primary outcome.
Eleven trials including a total of 590 patients were selected for the network meta-analysis. Compared with a chest tube alone, a chest tube with fibrinolytics, thoracotomy, and VATS were all associated with shorter LOS, with a mean difference of 5.05 days (95% CI, 2.46-7.64), 6.33 days (95% CI, 3.17-9.50), and 5.86 days (95% CI, 3.38-8.35), respectively. No substantial differences in LOS were observed between the latter three interventions. None of the 11 RCTs compared antibiotics alone vs other types of treatment. Most trials reported peri-procedural complications and the need for reintervention, but the descriptions differed significantly between trials, preventing meta-analysis. In trials reporting health care-associated costs, fibrinolytics had cost advantages compared with VATS. Short- and long-term morbidity and mortality were very low, regardless of the treatment modality.
The results of this network meta-analysis showed that a chest tube alone was associated with a longer LOS compared with other treatment modalities. The lower cost associated with a chest tube plus fibrinolytics warrants consideration when choosing between treatment options, given similar LOS and clinical outcomes compared with the other modalities.
In children with parapneumonic effusion or empyema, do hospital length of stay and other key clinical outcomes differ according to the treatment modality used?
A living systematic review of randomized controlled trials (RCTs) was conducted by searching the Cochrane Central Register of Controlled Trials, Embase, Latin American and Caribbean Health Sciences Literature, Ovid MEDLINE, and Web of Science Core Collection databases. Eligible RCTs included patients aged < 18 years and compared two of the following treatment modalities: antibiotics alone, chest tube insertion with or without fibrinolytics, video-assisted thoracoscopic surgery (VATS), and decortication via thoracotomy. A network meta-analysis was performed to evaluate treatment effects on hospital length of stay (LOS), the primary outcome.
Eleven trials including a total of 590 patients were selected for the network meta-analysis. Compared with a chest tube alone, a chest tube with fibrinolytics, thoracotomy, and VATS were all associated with shorter LOS, with a mean difference of 5.05 days (95% CI, 2.46-7.64), 6.33 days (95% CI, 3.17-9.50), and 5.86 days (95% CI, 3.38-8.35), respectively. No substantial differences in LOS were observed between the latter three interventions. None of the 11 RCTs compared antibiotics alone vs other types of treatment. Most trials reported peri-procedural complications and the need for reintervention, but the descriptions differed significantly between trials, preventing meta-analysis. In trials reporting health care-associated costs, fibrinolytics had cost advantages compared with VATS. Short- and long-term morbidity and mortality were very low, regardless of the treatment modality.
The results of this network meta-analysis showed that a chest tube alone was associated with a longer LOS compared with other treatment modalities. The lower cost associated with a chest tube plus fibrinolytics warrants consideration when choosing between treatment options, given similar LOS and clinical outcomes compared with the other modalities.
摘要：
背景：儿童社区获得性肺炎并发脓胸的最佳治疗方法尚不清楚。
目的：肺炎旁积液或脓胸患儿，住院时间和其他关键临床结果是否根据所使用的治疗方式而有所不同？
方法：通过搜索Cochrane中央对照试验登记册，对随机对照试验（RCT）进行了系统评价，Embase,拉丁美洲和加勒比健康科学文献，OvidMEDLINE,和WebofScience核心收藏数据库。符合条件的RCT包括年龄<18岁的患者，并比较了以下两种治疗方式：单独使用抗生素，有或没有纤维蛋白溶解剂的胸管插入，电视胸腔镜手术（VATS），和开胸手术。进行了网络荟萃分析(NMA)来评估治疗效果对住院时间(LOS)、主要结果。
结果：选择了11项试验，包括590名患者。与单独的胸管相比，带有纤维蛋白溶解剂的胸管，开胸手术,和VATS都与较短的LOS有关，平均差为5.05天(95%CI，2.46-7.64)，6.33天（95%CI，3.17-9.50），和5.86天（95%CI，3.38-8.35），分别。后三种干预措施之间的LOS没有实质性差异。11项RCT中没有一项将单独的抗生素与其他类型的治疗进行比较。大多数试验报告围手术期并发症和需要再干预，但是两次试验的描述有很大不同，防止荟萃分析。在报告医疗保健相关费用的试验中，与VATS相比,纤维蛋白溶解剂具有成本优势.短期和长期发病率和死亡率都很低，无论治疗方式如何。
结论：该NMA的结果表明，与其他治疗方式相比，单独使用胸管与更长的LOS相关。在选择治疗方案时，与胸管加纤维蛋白溶解剂相关的较低成本值得考虑。考虑到与其他模式相比相似的LOS和临床结局。
目的：肺炎旁积液或脓胸患儿，住院时间和其他关键临床结果是否根据所使用的治疗方式而有所不同？
方法：通过搜索Cochrane中央对照试验登记册，对随机对照试验（RCT）进行了系统评价，Embase,拉丁美洲和加勒比健康科学文献，OvidMEDLINE,和WebofScience核心收藏数据库。符合条件的RCT包括年龄<18岁的患者，并比较了以下两种治疗方式：单独使用抗生素，有或没有纤维蛋白溶解剂的胸管插入，电视胸腔镜手术（VATS），和开胸手术。进行了网络荟萃分析(NMA)来评估治疗效果对住院时间(LOS)、主要结果。
结果：选择了11项试验，包括590名患者。与单独的胸管相比，带有纤维蛋白溶解剂的胸管，开胸手术,和VATS都与较短的LOS有关，平均差为5.05天(95%CI，2.46-7.64)，6.33天（95%CI，3.17-9.50），和5.86天（95%CI，3.38-8.35），分别。后三种干预措施之间的LOS没有实质性差异。11项RCT中没有一项将单独的抗生素与其他类型的治疗进行比较。大多数试验报告围手术期并发症和需要再干预，但是两次试验的描述有很大不同，防止荟萃分析。在报告医疗保健相关费用的试验中，与VATS相比,纤维蛋白溶解剂具有成本优势.短期和长期发病率和死亡率都很低，无论治疗方式如何。
结论：该NMA的结果表明，与其他治疗方式相比，单独使用胸管与更长的LOS相关。在选择治疗方案时，与胸管加纤维蛋白溶解剂相关的较低成本值得考虑。考虑到与其他模式相比相似的LOS和临床结局。
