Early Administration of Steroids in the Ambulance Setting: An Observational Design Trial (EASI-AS-ODT).

Autor: Fishe JN; Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA.; Center for Data Solutions, University of Florida College of Medicine, Jacksonville, Florida, USA., Garvan G; Center for Data Solutions, University of Florida College of Medicine, Jacksonville, Florida, USA., Bertrand A; Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA., Burcham S; University of Florida College of Medicine, Gainesville, Florida, USA., Hendry P; Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA., Shah M; Baylor College of Medicine, Houston, Texas, USA., Kothari K; Baylor College of Medicine, Houston, Texas, USA., Ashby DW; Baylor College of Medicine, Houston, Texas, USA., Ostermeyer D; McGovern Medical School, University of Texas Health, Houston, Texas, USA., Riney L; Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA., Semenova O; Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA., Abo B; Lee County Emergency Medical Services, Fort Myers, Florida, USA.; Florida State University College of Medicine, Tallahassee, Florida, USA., Abes B; Lee County Emergency Medical Services, Fort Myers, Florida, USA., Shimko N; Golisano Children's Hospital of Southwest Florida, Fort Myers, Florida, USA., Myers E; Sarasota County Fire Department, Sarasota, Florida, USA., Frank M; Florida State University College of Medicine, Tallahassee, Florida, USA.; Sarasota County Fire Department, Sarasota, Florida, USA., Turner T; Walton County Fire Rescue, Defuniak Springs, Florida, USA., Kemp M; Leon County EMS, Tallahassee, Florida, USA., Landry K; Leon County EMS, Tallahassee, Florida, USA., Roland G; Nassau County Fire Rescue Department, Yulee, Florida, USA., Blake KV; Nemours Children's Health, Jacksonville, Florida, USA.
Jazyk: angličtina
Zdroj: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine [Acad Emerg Med] 2024 Jan; Vol. 31 (1), pp. 49-60. Date of Electronic Publication: 2023 Oct 19.
DOI: 10.1111/acem.14813
Abstrakt: Background: In the emergency department (ED), prompt administration of systemic corticosteroids for pediatric asthma exacerbations decreases hospital admission rates. However, there is sparse evidence for whether earlier administration of systemic corticosteroids by emergency medical services (EMS) clinicians, prior to ED arrival, further improves pediatric asthma outcomes.
Methods: Early Administration of Steroids in the Ambulance Setting: An Observational Design Trial is a multicenter, observational, nonrandomized stepped-wedge design study with seven participating EMS agencies who adopted an oral systemic corticosteroid (OCS) into their protocols for pediatric asthma treatment. Using univariate analyses and multivariable mixed-effects models, we compared hospital admission rates for pediatric asthma patients ages 2-18 years before and after the introduction of a prehospital OCS and for those who did and did not receive a systemic corticosteroid from EMS.
Results: A total of 834 patients were included, 21% of whom received a systemic corticosteroid from EMS. EMS administration of systemic corticosteroids increased after the introduction of an OCS from 14.7% to 28.1% (p < 0.001). However, there was no significant difference between hospital admission rates and ED length of stay before and after the introduction of OCS or between patients who did and did not receive a systemic corticosteroid from EMS. Mixed-effects models revealed that age 14-18 years (coefficient -0.83, p = 0.002), EMS administration of magnesium (coefficient 1.22, p = 0.04), and initial EMS respiratory severity score (coefficient 0.40, p < 0.001) were significantly associated with hospital admission.
Conclusions: In this multicenter study, the addition of an OCS into EMS agency protocols for pediatric asthma exacerbations significantly increased systemic corticosteroid administration but did not significantly decrease hospital admission rates. As overall EMS systemic corticosteroid administration rates were low, further work is required to understand optimal implementation of EMS protocol changes to better assess potential benefits to patients.
(© 2023 Society for Academic Emergency Medicine.)
Databáze: MEDLINE
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