Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is moderate or low to moderate where GRADE has been performed and there may be no difference in effectiveness between the intervention and comparison for key outcomes.
Population: Adults with parapneumonic effusions with or without empyema
Intervention: Intrapleural fibrinolytic therapy (alteplase or dornase alfa) ᵃ
Comparison: Placebo (intrapleural saline)
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Mortality (follow‐up: 3-36 months) | No statistically significant difference | Moderate |
Referral for thoracic surgery (follow‐up: 3-36 months) | Favours intervention ᵇ | Low |
Overall treatment failure (follow‐up: 3-36 months) | Favours intervention ᵇ | Very Low |
Serious adverse events | No statistically significant difference | Low |
Note ᵃ The Cochrane Clinical Answer (CCA) also included urokinase and streptokinase, but these drugs are not available in all countries. ᵇ The Cochrane review which underpins this CCA noted that in a sensitivity analysis considering only studies at low or unclear risk of bias, there was no statistically significant difference in effectiveness for these outcomes.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- What are the effects of intrapleural fibrinolytic therapy for parapneumonic effusions and empyema in adults?
- How do interventions for the management of malignant pleural effusions compare?
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