Ahmed 2016.

Methods	RCT Randomisation ratio: open thoracotomy:fibrinolytics = 43:35 Number of study centres: 1
Participants	N recruited = 78 N randomised =78 N reported outcomes = 78 Mean age = thoracotomy 55.53 years; fibrinolytics 56.42 years Gender m/f = 67/11 N fibrinolysis = 35 N thoracotomy = 43 Inclusion criteria: not described Exclusion criteria: not described
Interventions	Treatment before study: none reported Titration period and treatment: After diagnosis, participants were randomly allocated to receive either open thoracotomy or chest tube with fibrinolysis. Open thoracotomy: Postero‐lateral thoracotomy with complete decortication of parietal and visceral pleura. 2 large‐bore chest tubes (32Fr) were left in place following the procedure. Fibrinolysis: 14Fr chest tube inserted using Seldinger technique. 250,000 units of streptokinase in 100 mL normal saline was injected and left in place for 4 hours prior to draining. This was repeated every 24 hours for a maximum of 14 days. If drainage continued after 14 days, open drainage was performed. Common: For both procedures, chest tubes were removed when the drainage volume < 50 mL per day.
Outcomes	Duration of treatment, mean (SD) days: thoracotomy 13.95 (1.02) versus fibrinolysis 12.91 (1.01); P = 0.66 Treatment success, number of participants (%): thoracotomy 42 (97.7) versus fibrinolysis 30 (85.7); P = 0.04 Duration of hospitalisation, mean (SD) days: thoracotomy 12.09 (2.18) versus fibrinolysis 17.6 (1.95); P < 0.0001 Survival, number of participants (%): thoracotomy 42 (97.7) versus fibrinolysis 33 (94.3); P = 0.43
Notes	Language of publication: English Publication status: peer‐reviewed journal Stated aim for study: "To confirm that either Fibrinolytic therapy or open decortication which of the two is an effective First line treatment of pleural empyema." Funding: no funding Conflicts of interest: no conflicts of interest