SynthesisIndian pediatrics2026
Early Versus Late(r) Administration of Intrapleural Fibrinolytic Therapy in Children with Empyema: A Systematic Review and Meta-Analysis.
Synthesis in Indian pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
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Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
contextAlthough intrapleural fibrinolytic therapy (IPFT) is frequently used in empyema thoracis, there is lack of clarity regarding the ideal timing of its administration.
objectiveTo synthesize evidence comparing early IPFT (i.e. at presentation, or as early as feasible, but within 24 h of confirmation of empyema), versus late(r) instillation (i.e. after 24 h of confirmation of empyema) in children with empyema, for the purpose of framing an evidence-based guideline recommendation. EVIDENCE ACQUISITION: We searched for randomized controlled trials (RCTs) comparing early versus late(r) IPFT in children (< 18y) with confirmed empyema, through five databases of published literature viz. PubMed, EMBASE, the Cochrane Library, Web of Science (WOS), and Scopus, two grey literature databases (ProQuest and OpenGrey), and four clinical trial registries. There were no restrictions or filters used. A three-step approach was implemented to screen and select studies eligible for inclusion. The patient-centric outcomes evaluated were indicators of treatment failure, clinical outcomes, pulmonary function tests, adverse events and cost of therapy. We planned to calculate pooled odds ratios (OR), and mean differences (MDs) with 95% confidence intervals (CIs) for dichotomous and continuous outcomes respectively. The certainty of evidence was to be assessed using the GRADE approach.
resultsThe comprehensive search identified 3,110 citations, however there was no RCT addressing the review question.
conclusionsThere are no RCTs comparing early versus late(r) use of fibrinolytic therapy in childhood empyema. Well-designed randomized controlled trials are required to address the question. Evidence-based guidance on the question must use additional considerations, until RCT evidence is available.
trial registrationThe protocol of the systematic review was registered in the PROSPERO database (ID: CRD42024516041) on March 03, 2024.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.