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We were interested to read Pierrepoint et al’s short report in October’s edition of Archives,1 which concluded that first line treatment of empyema thoracis should be with a pigtail catheter drain and urokinase. However, there is still ongoing debate as whether empyema thoracis is best treated like this2 or by open thoracotomy and decortication.3 It is interesting that the inpatient days for both therapeutic methods have been found to be similar.2,3 However, both reports are case series. Is it not time that a randomised control trial was performed comparing the two methods to aid paediatricians in the management of empyema thoracis?
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