Irene R Kelly, Thomas Laudone, Richard Lichenstein, Kristine A Parbuoni
{"title":"评估小儿哮喘加重时的地塞米松剂量策略","authors":"Irene R Kelly, Thomas Laudone, Richard Lichenstein, Kristine A Parbuoni","doi":"10.5863/1551-6776-28.8.735","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to determine if there is a difference in health care use in pediatric asthma exacerbations with dexamethasone at a standardized dose compared with a weight-based approach. .</p><p><strong>Methods: </strong>This was a single-center, retrospective study of patients ages 2 to 17 years presenting to the pediatric emergency department (ED) with an asthma exacerbation between July 1, 2018, and June 30, 2021. Patients who received at least 1 dose of dexamethasone and had an <i>International Classification of Diseases</i>, 10th revision (ICD-10) code for asthma were included. The primary end point was the rate of return visits to the ED within 30 days and 31 to 90 days. Secondary end points included incidence of hospitalization and intubation, length of stay, dexamethasone dosing discrepancies, other corticosteroids or adjunctive therapies used, and medication escalation at discharge. The incidences of vomiting, hyperglycemia, and hypertension were also evaluated. Descriptive statistics were used for categoric variables and a Kaplan-Meier survival curve and Cox regression evaluated the primary outcome.</p><p><strong>Results: </strong>A total of 252 patients were included, 162 in the standardized dosing group and 90 in the weight-based group. There was no difference in return visits at 30 days and 31 to 90 days (3.1 vs 4.4, p = 0.58; and 3.7 vs 7.8, p = 0.16). The standardized group had a statistically significant shorter length of stay and lower ipratropium and magnesium use compared with the weight-based group. However, hospitalization rates were lower overall in the weight-based group. The incidences of vomiting, hyperglycemia, and hypertension were similar.</p><p><strong>Conclusions: </strong>A standardized dosing strategy for dexamethasone in pediatric asthma exacerbations showed favorable outcomes and may lead to improved adherence.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10715385/pdf/","citationCount":"0","resultStr":"{\"title\":\"Evaluation of Dexamethasone Dosing Strategies in Pediatric Asthma Exacerbations.\",\"authors\":\"Irene R Kelly, Thomas Laudone, Richard Lichenstein, Kristine A Parbuoni\",\"doi\":\"10.5863/1551-6776-28.8.735\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>This study aimed to determine if there is a difference in health care use in pediatric asthma exacerbations with dexamethasone at a standardized dose compared with a weight-based approach. .</p><p><strong>Methods: </strong>This was a single-center, retrospective study of patients ages 2 to 17 years presenting to the pediatric emergency department (ED) with an asthma exacerbation between July 1, 2018, and June 30, 2021. Patients who received at least 1 dose of dexamethasone and had an <i>International Classification of Diseases</i>, 10th revision (ICD-10) code for asthma were included. The primary end point was the rate of return visits to the ED within 30 days and 31 to 90 days. Secondary end points included incidence of hospitalization and intubation, length of stay, dexamethasone dosing discrepancies, other corticosteroids or adjunctive therapies used, and medication escalation at discharge. The incidences of vomiting, hyperglycemia, and hypertension were also evaluated. Descriptive statistics were used for categoric variables and a Kaplan-Meier survival curve and Cox regression evaluated the primary outcome.</p><p><strong>Results: </strong>A total of 252 patients were included, 162 in the standardized dosing group and 90 in the weight-based group. There was no difference in return visits at 30 days and 31 to 90 days (3.1 vs 4.4, p = 0.58; and 3.7 vs 7.8, p = 0.16). The standardized group had a statistically significant shorter length of stay and lower ipratropium and magnesium use compared with the weight-based group. However, hospitalization rates were lower overall in the weight-based group. The incidences of vomiting, hyperglycemia, and hypertension were similar.</p><p><strong>Conclusions: </strong>A standardized dosing strategy for dexamethasone in pediatric asthma exacerbations showed favorable outcomes and may lead to improved adherence.</p>\",\"PeriodicalId\":37484,\"journal\":{\"name\":\"Journal of Pediatric Pharmacology and Therapeutics\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10715385/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Pediatric Pharmacology and Therapeutics\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.5863/1551-6776-28.8.735\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/12/12 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Pediatric Pharmacology and Therapeutics","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5863/1551-6776-28.8.735","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/12/12 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}
Evaluation of Dexamethasone Dosing Strategies in Pediatric Asthma Exacerbations.
Objectives: This study aimed to determine if there is a difference in health care use in pediatric asthma exacerbations with dexamethasone at a standardized dose compared with a weight-based approach. .
Methods: This was a single-center, retrospective study of patients ages 2 to 17 years presenting to the pediatric emergency department (ED) with an asthma exacerbation between July 1, 2018, and June 30, 2021. Patients who received at least 1 dose of dexamethasone and had an International Classification of Diseases, 10th revision (ICD-10) code for asthma were included. The primary end point was the rate of return visits to the ED within 30 days and 31 to 90 days. Secondary end points included incidence of hospitalization and intubation, length of stay, dexamethasone dosing discrepancies, other corticosteroids or adjunctive therapies used, and medication escalation at discharge. The incidences of vomiting, hyperglycemia, and hypertension were also evaluated. Descriptive statistics were used for categoric variables and a Kaplan-Meier survival curve and Cox regression evaluated the primary outcome.
Results: A total of 252 patients were included, 162 in the standardized dosing group and 90 in the weight-based group. There was no difference in return visits at 30 days and 31 to 90 days (3.1 vs 4.4, p = 0.58; and 3.7 vs 7.8, p = 0.16). The standardized group had a statistically significant shorter length of stay and lower ipratropium and magnesium use compared with the weight-based group. However, hospitalization rates were lower overall in the weight-based group. The incidences of vomiting, hyperglycemia, and hypertension were similar.
Conclusions: A standardized dosing strategy for dexamethasone in pediatric asthma exacerbations showed favorable outcomes and may lead to improved adherence.
期刊介绍:
The Journal of Pediatric Pharmacology and Therapeutics is the official journal of the Pediatric Pharmacy Advocacy Group. JPPT is a peer-reviewed multi disciplinary journal that is devoted to promoting the safe and effective use of medications in infants and children. To this end, the journal publishes practical information for all practitioners who provide care to pediatric patients. Each issue includes review articles, original clinical investigations, case reports, editorials, and other information relevant to pediatric medication therapy. The Journal focuses all work on issues related to the practice of pediatric pharmacology and therapeutics. The scope of content includes pharmacotherapy, extemporaneous compounding, dosing, methods of medication administration, medication error prevention, and legislative issues. The Journal will contain original research, review articles, short subjects, case reports, clinical investigations, editorials, and news from such organizations as the Pediatric Pharmacy Advocacy Group, the FDA, the American Academy of Pediatrics, the American Society of Health-System Pharmacists, and so on.