Prioritizing Hormone Therapy Over Vigabatrin as the First Treatment for Infantile Spasms: A Quality Improvement Initiative.

Autor:	Mytinger JR; From the Division of Pediatric Neurology (J.R.M., S.M.A., D.V.F.A., C.W.B., A.P.O., J.D.E.T., J.V., A.D.P.), Department of Pediatrics, Nationwide Children's Hospital, and The Ohio State University; The Center for Clinical Excellence (W.P., A.D.P.) ; Information Technology Research & Innovation (S.W.R.), and Division of Pediatric Neurology (J.C., D.J.C., A.D., D.D., M.K., J.H., M.C.T.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH. john.mytinger@nationwidechildrens.org., Parker W; From the Division of Pediatric Neurology (J.R.M., S.M.A., D.V.F.A., C.W.B., A.P.O., J.D.E.T., J.V., A.D.P.), Department of Pediatrics, Nationwide Children's Hospital, and The Ohio State University; The Center for Clinical Excellence (W.P., A.D.P.) ; Information Technology Research & Innovation (S.W.R.), and Division of Pediatric Neurology (J.C., D.J.C., A.D., D.D., M.K., J.H., M.C.T.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH., Rust SW; From the Division of Pediatric Neurology (J.R.M., S.M.A., D.V.F.A., C.W.B., A.P.O., J.D.E.T., J.V., A.D.P.), Department of Pediatrics, Nationwide Children's Hospital, and The Ohio State University; The Center for Clinical Excellence (W.P., A.D.P.) ; Information Technology Research & Innovation (S.W.R.), and Division of Pediatric Neurology (J.C., D.J.C., A.D., D.D., M.K., J.H., M.C.T.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH., Ahrens SM; From the Division of Pediatric Neurology (J.R.M., S.M.A., D.V.F.A., C.W.B., A.P.O., J.D.E.T., J.V., A.D.P.), Department of Pediatrics, Nationwide Children's Hospital, and The Ohio State University; The Center for Clinical Excellence (W.P., A.D.P.) ; Information Technology Research & Innovation (S.W.R.), and Division of Pediatric Neurology (J.C., D.J.C., A.D., D.D., M.K., J.H., M.C.T.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH., Albert DVF; From the Division of Pediatric Neurology (J.R.M., S.M.A., D.V.F.A., C.W.B., A.P.O., J.D.E.T., J.V., A.D.P.), Department of Pediatrics, Nationwide Children's Hospital, and The Ohio State University; The Center for Clinical Excellence (W.P., A.D.P.) ; Information Technology Research & Innovation (S.W.R.), and Division of Pediatric Neurology (J.C., D.J.C., A.D., D.D., M.K., J.H., M.C.T.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH., Beatty CW; From the Division of Pediatric Neurology (J.R.M., S.M.A., D.V.F.A., C.W.B., A.P.O., J.D.E.T., J.V., A.D.P.), Department of Pediatrics, Nationwide Children's Hospital, and The Ohio State University; The Center for Clinical Excellence (W.P., A.D.P.) ; Information Technology Research & Innovation (S.W.R.), and Division of Pediatric Neurology (J.C., D.J.C., A.D., D.D., M.K., J.H., M.C.T.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH., Chrisman J; From the Division of Pediatric Neurology (J.R.M., S.M.A., D.V.F.A., C.W.B., A.P.O., J.D.E.T., J.V., A.D.P.), Department of Pediatrics, Nationwide Children's Hospital, and The Ohio State University; The Center for Clinical Excellence (W.P., A.D.P.) ; Information Technology Research & Innovation (S.W.R.), and Division of Pediatric Neurology (J.C., D.J.C., A.D., D.D., M.K., J.H., M.C.T.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH., Clark DJ; From the Division of Pediatric Neurology (J.R.M., S.M.A., D.V.F.A., C.W.B., A.P.O., J.D.E.T., J.V., A.D.P.), Department of Pediatrics, Nationwide Children's Hospital, and The Ohio State University; The Center for Clinical Excellence (W.P., A.D.P.) ; Information Technology Research & Innovation (S.W.R.), and Division of Pediatric Neurology (J.C., D.J.C., A.D., D.D., M.K., J.H., M.C.T.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH., Debs A; From the Division of Pediatric Neurology (J.R.M., S.M.A., D.V.F.A., C.W.B., A.P.O., J.D.E.T., J.V., A.D.P.), Department of Pediatrics, Nationwide Children's Hospital, and The Ohio State University; The Center for Clinical Excellence (W.P., A.D.P.) ; Information Technology Research & Innovation (S.W.R.), and Division of Pediatric Neurology (J.C., D.J.C., A.D., D.D., M.K., J.H., M.C.T.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH., Denney D; From the Division of Pediatric Neurology (J.R.M., S.M.A., D.V.F.A., C.W.B., A.P.O., J.D.E.T., J.V., A.D.P.), Department of Pediatrics, Nationwide Children's Hospital, and The Ohio State University; The Center for Clinical Excellence (W.P., A.D.P.) ; Information Technology Research & Innovation (S.W.R.), and Division of Pediatric Neurology (J.C., D.J.C., A.D., D.D., M.K., J.H., M.C.T.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH., Karn M; From the Division of Pediatric Neurology (J.R.M., S.M.A., D.V.F.A., C.W.B., A.P.O., J.D.E.T., J.V., A.D.P.), Department of Pediatrics, Nationwide Children's Hospital, and The Ohio State University; The Center for Clinical Excellence (W.P., A.D.P.) ; Information Technology Research & Innovation (S.W.R.), and Division of Pediatric Neurology (J.C., D.J.C., A.D., D.D., M.K., J.H., M.C.T.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH., Herbst J; From the Division of Pediatric Neurology (J.R.M., S.M.A., D.V.F.A., C.W.B., A.P.O., J.D.E.T., J.V., A.D.P.), Department of Pediatrics, Nationwide Children's Hospital, and The Ohio State University; The Center for Clinical Excellence (W.P., A.D.P.) ; Information Technology Research & Innovation (S.W.R.), and Division of Pediatric Neurology (J.C., D.J.C., A.D., D.D., M.K., J.H., M.C.T.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH., Ostendorf AP; From the Division of Pediatric Neurology (J.R.M., S.M.A., D.V.F.A., C.W.B., A.P.O., J.D.E.T., J.V., A.D.P.), Department of Pediatrics, Nationwide Children's Hospital, and The Ohio State University; The Center for Clinical Excellence (W.P., A.D.P.) ; Information Technology Research & Innovation (S.W.R.), and Division of Pediatric Neurology (J.C., D.J.C., A.D., D.D., M.K., J.H., M.C.T.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH., Taylor MC; From the Division of Pediatric Neurology (J.R.M., S.M.A., D.V.F.A., C.W.B., A.P.O., J.D.E.T., J.V., A.D.P.), Department of Pediatrics, Nationwide Children's Hospital, and The Ohio State University; The Center for Clinical Excellence (W.P., A.D.P.) ; Information Technology Research & Innovation (S.W.R.), and Division of Pediatric Neurology (J.C., D.J.C., A.D., D.D., M.K., J.H., M.C.T.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH., Twanow JDE; From the Division of Pediatric Neurology (J.R.M., S.M.A., D.V.F.A., C.W.B., A.P.O., J.D.E.T., J.V., A.D.P.), Department of Pediatrics, Nationwide Children's Hospital, and The Ohio State University; The Center for Clinical Excellence (W.P., A.D.P.) ; Information Technology Research & Innovation (S.W.R.), and Division of Pediatric Neurology (J.C., D.J.C., A.D., D.D., M.K., J.H., M.C.T.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH., Vidaurre J; From the Division of Pediatric Neurology (J.R.M., S.M.A., D.V.F.A., C.W.B., A.P.O., J.D.E.T., J.V., A.D.P.), Department of Pediatrics, Nationwide Children's Hospital, and The Ohio State University; The Center for Clinical Excellence (W.P., A.D.P.) ; Information Technology Research & Innovation (S.W.R.), and Division of Pediatric Neurology (J.C., D.J.C., A.D., D.D., M.K., J.H., M.C.T.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH., Patel AD; From the Division of Pediatric Neurology (J.R.M., S.M.A., D.V.F.A., C.W.B., A.P.O., J.D.E.T., J.V., A.D.P.), Department of Pediatrics, Nationwide Children's Hospital, and The Ohio State University; The Center for Clinical Excellence (W.P., A.D.P.) ; Information Technology Research & Innovation (S.W.R.), and Division of Pediatric Neurology (J.C., D.J.C., A.D., D.D., M.K., J.H., M.C.T.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.
Jazyk:	angličtina
Zdroj:	Neurology [Neurology] 2022 Nov 08; Vol. 99 (19), pp. e2171-e2180. Date of Electronic Publication: 2022 Aug 29.
DOI:	10.1212/WNL.0000000000201113
Abstrakt:	Background and Objectives: Infantile spasms (IS) are early childhood seizures with potentially devastating consequences. Standard therapies (adrenocorticotropic hormone [ACTH], high-dose prednisolone, and vigabatrin) are strongly recommended as the first treatment for IS. Although this recommendation comes without preference for one standard therapy over another, early remission rates are higher with hormone therapy (ACTH and high-dose prednisolone) when compared with vigabatrin. Using quality improvement (QI) methodology that included hormone therapy as the first treatment, we sought to increase the percentage of children with new-onset nontuberous sclerosis complex (TSC)-associated IS achieving 3-month electroclinical remission from a mean of 53.8% to ≥70%. Methods: This was an observational consecutive sample cohort study at a single academic tertiary care hospital that compared a prospective intervention cohort (May 2019-January 2022, N = 57) with a retrospective baseline cohort (November 2015-April 2019, N = 67). Our initiative addressed key drivers such as the routine use of vigabatrin over hormone therapy as first treatment and the common initiation of a second treatment after 14 days for initial nonresponders. We included consecutive children without TSC presenting with new-onset IS diagnosed and treated between ages 2 and 24 months. We displayed our primary outcome and process measures as control charts in which the centerline is the quarterly (previous 3 months) mean based on statistical process control methodology. Results: QI interventions that included the standardization of hormone therapy as the first treatment resulted in higher rates of 3-month remission, rising from 53.8% (baseline cohort) to 75.9% (intervention cohort). Process measure results included an increased rate of children receiving hormone therapy as first treatment (mean, 44.6%-100%) and a decreased number of days to both clinical follow-up after first treatment (mean, of 16.3-12.6 days) and starting a second treatment within 14 days for initial nonresponders (mean, 36.3-17.2 days). Discussion: For children with IS, improved rates of 3-month electroclinical remission can be achieved with QI methodology. Implementation of similar QI initiatives at other centers may likewise improve local remission rates. (© 2022 American Academy of Neurology.)
Databáze:	MEDLINE
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