Outcomes for Pediatric Asthmatic Inpatients After Implementation of an Emergency Department Dexamethasone Treatment Protocol.
Outcomes for Pediatric Asthmatic Inpatients After Implementation of an Emergency Department Dexamethasone Treatment Protocol.
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DOI：
10.1542/hpeds.2018-0099
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发表时间：
2019-02-01
影响因子：
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通讯作者：
Hoch, Heather
中科院分区：
文献类型：
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作者：
Tyler, Amy;Cotter, Jillian M;Hoch, Heather
目的：有证据支持在急诊室使用地塞米松治疗轻中度哮喘急性发作，但地塞米松与泼尼松相比，对住院哮喘患者的有效性尚不清楚。我们的目的是比较急诊科采用地塞米松治疗哮喘急性发作前后住院患者的结局。方法：在这项单中心回顾性队列研究中，我们采用中断时间序列分析来控制长期趋势，同时评估住院时间、通货膨胀调整后的总住院费用和哮喘患者的ICU转移率。结果：分析了36个月（2014年1月至2017年4月）的数据，包括1015例受试者（方案变更前[PC前]组606例，方案变更后[PC后]组409例）。在PC前组中，96%的受试者仅使用泼尼松。在PC后组中，7%的受试者仅使用泼尼松，65%的受试者使用地塞米松，28%的受试者联合使用2种类固醇。控制中断时间序列模型中的其他变量，我们发现PC前和PC后期间的住院时间（P = 0.68），总费用（P = 0.66）和ICU转移（P = 0.98）的结果没有显着的直接差异。ICU转移率在PC前稳定，增加了10%（95%置信区间：2%-19%）（比值比= 1.10; 95%可信区间：1.02-1.19; P = 0.02）。结论：在地塞米松取代泼尼松成为我们机构住院哮喘患者最常用的类固醇处方后，我们发现哮喘患者住院治疗的结果没有立即改变，但ICU转移率呈上升趋势。
OBJECTIVES: Evidence supports using dexamethasone for mild-to-moderate asthma exacerbations in the emergency department, but the effectiveness of dexamethasone versus prednisone for asthmatic patients who are hospitalized is unclear. Our aim was to compare outcomes for inpatients before and after our emergency department's adoption of dexamethasone for the treatment of acute asthma exacerbations.METHODS: In this single-center retrospective cohort study, we employed interrupted time series analyses to control for secular trends while evaluating our outcomes of length of stay, total inflation-adjusted hospital charges, and ICU transfer rates for patients admitted with asthma.RESULTS: Data were analyzed over 36 months (January 2014-April 2017) and included 1015 subjects (606 in the preprotocol change [pre-PC] group and 409 in the postprotocol change [post-PC] group). In the pre-PC group, prednisone only was used in 96% of subjects. In the post-PC group, prednisone only was used in 7% of subjects, dexamethasone in 65% of subjects, and a combination of the 2 steroids in 28% of subjects. Controlling for other variables in the interrupted time series model, we found no significant immediate differences between the pre-PC and post-PC periods for the outcomes of length of stay (P = .68), total charges (P = .66), and ICU transfers (P = .98). The rate of ICU transfers was stable pre-PC and increased by 10% (95% confidence interval: 2%-19%) per month (odds ratio = 1.10; 95% confidence interval: 1.02-1.19; P = .02) in the post-PC period.CONCLUSIONS: After dexamethasone replaced prednisone as the most commonly prescribed steroid type for inpatients with asthma at our institution, we found no immediate changes in outcomes for asthmatic patients who were hospitalized but an upward trend in ICU transfers.