Rates of Stress Ulcer Prophylaxis Deprescribing in Children Receiving Usual versus High-Dose Corticosteroids in the Pediatric Intensive Care Unit with Status Asthmaticus.

IF 0.8 Q4 PHARMACOLOGY & PHARMACY
Hospital Pharmacy Pub Date : 2024-12-01 Epub Date: 2024-08-05 DOI:10.1177/00185787241267723
Avery Parman, Jamie L Miller, Stephen Neely, Peter N Johnson, Neha Gupta
{"title":"Rates of Stress Ulcer Prophylaxis Deprescribing in Children Receiving Usual versus High-Dose Corticosteroids in the Pediatric Intensive Care Unit with Status Asthmaticus.","authors":"Avery Parman, Jamie L Miller, Stephen Neely, Peter N Johnson, Neha Gupta","doi":"10.1177/00185787241267723","DOIUrl":null,"url":null,"abstract":"<p><p><b>Purpose:</b> To compare deprescribing rates of stress ulcer prophylaxis (SUP) between children receiving \"usual-dose\" (<4 mg/kg/day methylprednisolone equivalents) versus \"high-dose\" (≥4 mg/kg/day methylprednisolone equivalents) corticosteroids for status asthmaticus in the pediatric intensive care unit (PICU). <b>Methods:</b> This retrospective, cohort study included children <18 years of age receiving corticosteroids for status asthmaticus and SUP from 1/1/2017 to 6/31/2022. The primary objective was to compare the number of children that were deprescribed SUP following transition from the PICU to the floor and at hospital discharge between groups. Secondary objectives included a comparison of SUP-associated adverse events (ADEs) (pneumonia, <i>Clostridium difficile</i> colitis, thrombocytopenia, necrotizing enterocolitis) between groups. Comparisons were performed using exact <i>χ<sup>2</sup></i> test or Wilcoxon <i>U</i>-tests as appropriate, with a <i>P</i> value <.05. <b>Results:</b> Ninety-six patients received usual-dose and 57 received high-dose corticosteroids. Eighteen (11.8%) patients were transferred within 24 hours of PICU admission and started on SUP on the floor. Thirteen (8.5%) patients were discharged home from the PICU. The remaining 122 (79.7%) patients were transferred from PICU to the floor and there was no statistical difference for continuation of SUP on the floor between usual-dose versus high-dose group, 58 (76.3%) versus 31 (67.4%) patients, <i>P</i> = .282. Overall, 25 of 153 (16.3%) patients were discharged home on SUP, but there was no difference between groups. SUP-associated ADEs did not differ between groups. <b>Conclusions:</b> SUP continuation during transitions of care in this cohort was common. Assessment of SUP continuation is needed during transitions of care to promote SUP stewardship and limit risk of SUP-associated ADEs.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"59 6","pages":"677-683"},"PeriodicalIF":0.8000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528814/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hospital Pharmacy","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/00185787241267723","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/8/5 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
引用次数: 0

Abstract

Purpose: To compare deprescribing rates of stress ulcer prophylaxis (SUP) between children receiving "usual-dose" (<4 mg/kg/day methylprednisolone equivalents) versus "high-dose" (≥4 mg/kg/day methylprednisolone equivalents) corticosteroids for status asthmaticus in the pediatric intensive care unit (PICU). Methods: This retrospective, cohort study included children <18 years of age receiving corticosteroids for status asthmaticus and SUP from 1/1/2017 to 6/31/2022. The primary objective was to compare the number of children that were deprescribed SUP following transition from the PICU to the floor and at hospital discharge between groups. Secondary objectives included a comparison of SUP-associated adverse events (ADEs) (pneumonia, Clostridium difficile colitis, thrombocytopenia, necrotizing enterocolitis) between groups. Comparisons were performed using exact χ2 test or Wilcoxon U-tests as appropriate, with a P value <.05. Results: Ninety-six patients received usual-dose and 57 received high-dose corticosteroids. Eighteen (11.8%) patients were transferred within 24 hours of PICU admission and started on SUP on the floor. Thirteen (8.5%) patients were discharged home from the PICU. The remaining 122 (79.7%) patients were transferred from PICU to the floor and there was no statistical difference for continuation of SUP on the floor between usual-dose versus high-dose group, 58 (76.3%) versus 31 (67.4%) patients, P = .282. Overall, 25 of 153 (16.3%) patients were discharged home on SUP, but there was no difference between groups. SUP-associated ADEs did not differ between groups. Conclusions: SUP continuation during transitions of care in this cohort was common. Assessment of SUP continuation is needed during transitions of care to promote SUP stewardship and limit risk of SUP-associated ADEs.

在儿科重症监护病房接受普通剂量与大剂量皮质类固醇治疗的哮喘患儿中,应激性溃疡预防性处方取消率。
目的:比较接受 "常规剂量"(方法:包括艰难梭菌性结肠炎、血小板减少症、坏死性小肠结肠炎)治疗的儿童的应激性溃疡预防药(SUP)的停药率:这项回顾性队列研究包括艰难梭菌性结肠炎、血小板减少症、坏死性小肠结肠炎患儿)之间的处方率。比较采用精确的 χ2 检验或 Wilcoxon U 检验,P 值为结果:96 名患者接受了常规剂量皮质类固醇治疗,57 名患者接受了高剂量皮质类固醇治疗。有 18 名患者(11.8%)在入院后 24 小时内转入重症监护病房,并开始在病房内使用 SUP。13名(8.5%)患者从重症监护病房出院回家。其余 122 名(79.7%)患者从 PICU 转至病房,在病房继续使用 SUP 的普通剂量组和高剂量组之间没有统计学差异,分别为 58 名(76.3%)患者和 31 名(67.4%)患者,P = .282。总体而言,153 名患者中有 25 名(16.3%)在使用 SUP 后出院回家,但组间没有差异。与 SUP 相关的 ADE 在各组之间没有差异。结论在该队列中,在护理过渡期间继续使用 SUP 的情况很常见。需要在护理过渡期间对 SUP 的持续性进行评估,以促进 SUP 的管理并限制 SUP 相关 ADE 的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Hospital Pharmacy
Hospital Pharmacy PHARMACOLOGY & PHARMACY-
CiteScore
1.70
自引率
0.00%
发文量
63
期刊介绍: Hospital Pharmacy is a monthly peer-reviewed journal that is read by pharmacists and other providers practicing in the inpatient and outpatient setting within hospitals, long-term care facilities, home care, and other health-system settings The Hospital Pharmacy Assistant Editor, Michael R. Cohen, RPh, MS, DSc, FASHP, is author of a Medication Error Report Analysis and founder of The Institute for Safe Medication Practices (ISMP), a nonprofit organization that provides education about adverse drug events and their prevention.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信