Wide Institutional Variability in the Treatment of Pediatric Critical Asthma: A Multicenter Retrospective Study.

Autor:	Rogerson CM; Division of Pediatric Critical Care Medicine, Indiana University School of Medicine, Indianapolis, IN., Hogan AH; Division of Hospital Medicine, Connecticut Children's Medical Center, Hartford, CT., Waldo B; Department of Respiratory Therapy, Rainbow Babies and Children's Hospital, Cleveland, OH., White BR; Division of Pediatric Critical Care Medicine, University of Utah, Salt Lake City, UT., Carroll CL; Department of Pediatrics, Wolfson Children's, University of Florida, Jacksonville, FL., Shein SL; Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH.
Jazyk:	angličtina
Zdroj:	Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies [Pediatr Crit Care Med] 2024 Jan 01; Vol. 25 (1), pp. 37-46. Date of Electronic Publication: 2023 Aug 24.
DOI:	10.1097/PCC.0000000000003347
Abstrakt:	Objectives: Children with status asthmaticus refractory to first-line therapies of systemic corticosteroids and inhaled beta-agonists often receive additional treatments. Because there are no national guidelines on the use of asthma therapies in the PICU, we sought to evaluate institutional variability in the use of adjunctive asthma treatments and associations with length of stay (LOS) and PICU use. Design: Multicenter retrospective cohort study. Setting: Administrative data from the Pediatric Health Information Systems (PHIS) database. Patients: All inpatients 2-18 years old were admitted to a PHIS hospital between 2013 and 2021 with a diagnostic code for asthma. Interventions: None. Measurements and Main Results: This study included 213,506 inpatient encounters for asthma, of which 29,026 patient encounters included care in a PICU from 39 institutions. Among these PICU encounters, large variability was seen across institutions in both the number of adjunctive asthma therapies used per encounter (min: 0.6, median: 1.7, max: 2.5, p < 0.01) and types of adjunctive asthma therapies (aminophylline, ipratropium, magnesium, epinephrine, and terbutaline) used. The center-level median hospital LOS ranged from 1 (interquartile range [IQR]: 1, 3) to 4 (3, 6) days. Among all the 213,506 inpatient encounters for asthma, the range of asthma admissions that resulted in PICU admission varied between centers from 5.2% to 47.3%. The average number of adjunctive therapies used per institution was not significantly associated with hospital LOS ( p = 0.81) nor the percentage of encounters with PICU admission ( p = 0.47). Conclusions: Use of adjunctive therapies for status asthmaticus varies widely among large children's hospitals and was not associated with hospital LOS or the percentage of encounters with PICU admission. Wide variance presents an opportunity for standardizing care with evidence-based guidelines to optimize outcomes and decrease adverse treatment effects and hospital costs. Competing Interests: Dr. Shein received funding from Ceribell and Hill Ward Henderson. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)
Databáze:	MEDLINE
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