Steroid variability in pediatric inpatient asthmatics: survey on provider preferences of dexamethasone versus prednisone.
Steroid variability in pediatric inpatient asthmatics: survey on provider preferences of dexamethasone versus prednisone.
复制标题
儿科住院哮喘患者的类固醇变异性：对地塞米松与泼尼松的提供者偏好的调查。
DOI：
10.1080/02770903.2019.1622713
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Hoch,HeatherE
中科院分区：
文献类型：
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作者：
Cotter,JillianM;Tyler,Amy;Reese,Jennifer;Ziniel,Sonja;Federico,MonicaJ;AndersonIii,WilliamC;Kupfer,Oren;Szefler,StanleyJ;Kerby,Gwendolyn;Hoch,HeatherE
目的：我院儿科急诊科（艾德）在艾德研究显示地塞米松与泼尼松相比具有非劣效性后，开始使用地塞米松治疗哮喘急性发作。然而，供应商尚未就最佳住院类固醇方案达成共识。本研究评估住院类固醇treatment.Methods供应商的偏好：一项调查被分发给供应商谁照顾住院儿童哮喘。受访者回答有关类固醇的选择和时机的问题。数据汇总为百分比;双变量比较进行了分析与皮尔逊卡方test.Results：92供应商完成了调查（60%的响应率）。当患者在艾德接受地塞米松治疗时，随后的住院管理是可变的：44%继续使用地塞米松，14%改用泼尼松，2%表示没有额外的类固醇，40%表示取决于情况。住院医师比肺科医师更可能继续使用地塞米松（分别为61%和15%;p<0.001）。影响供应商在住院环境中改用泼尼松的因素包括急性加重的严重程度（73%）和哮喘史（47%）。51%的人使用地塞米松感到不舒服，因为“支持住院使用的数据很少”。在基于病例的问题中，28%的人选择的地塞米松给药间隔超出了推荐范围。13%的患者报告在临床实践中遇到错误。结论：在艾德治疗哮喘急性发作时使用地塞米松导致住院患者类固醇处方实践的不确定性。供应商经常恢复到泼尼松，特别是在严重的哮喘急性发作，可能是由于泼尼松的经验和有限的研究地塞米松在住院设置。需要进一步研究比较地塞米松和泼尼松在不同病情严重程度的住院哮喘儿童中的有效性。
Objective: Our hospital’s pediatric Emergency Department (ED) began using dexamethasone for treating asthma exacerbations after ED studies showed non-inferiority of dexamethasone compared to prednisone. However, providers have not reached consensus on optimal inpatient steroid regimen. This study evaluates provider preference for inpatient steroid treatment.Methods: A survey was distributed to providers who care for inpatient pediatric asthmatics. Respondents answered questions about steroid choice and timing. Data were summarized as percentages; bivariate comparisons were analyzed with Pearson’s chi-squared test.Results: Ninety-two providers completed the survey (60% response rate). When patients received dexamethasone in the ED, subsequent inpatient management was variable: 44% continued dexamethasone, 14% switched to prednisone, 2% said no additional steroids, and 40% said it depended on the scenario. Hospitalists were more likely to continue dexamethasone than pulmonologists (61% and 15%, respectively;p< .001). Factors that influenced providers to switch to prednisone in the inpatient setting included severity of exacerbation (73%) and asthma history (47%). Fifty-one percent felt uncomfortable using dexamethasone because of “minimal data to support [its] use inpatient.” In case-based questions, 28% selected dexamethasone dosing intervals outside the recommended range. Thirteen percent reported experiencing errors in clinical practice.Conclusions: Use of dexamethasone in the ED for asthma exacerbations has led to uncertainty in inpatient steroid prescribing practices. Providers often revert to prednisone, especially in severe asthma exacerbations, possibly due to experience with prednisone and limited research on dexamethasone in the inpatient setting. Further research comparing the effectiveness of dexamethasone to prednisone in inpatient asthmatic children with various severities of illness is needed.