Sneller Hannah, Carroll Christopher L, Welch Kristin, Sturm Jesse
Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT, USA.
Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA.
J Asthma. 2020 Apr;57(4):405-409. doi: 10.1080/02770903.2019.1579343. Epub 2019 Feb 22.
: Our goal was to assess factors associated with non-response to treatment in children presenting to the Emergency Department (ED) with moderate and severe asthma exacerbations. : A retrospective chart review was completed from 9/2014 to 2/2017 for patients with a discharge diagnosis of asthma exacerbation. The Modified Pulmonary Index Score (MPIS) was used to quantify illness acuity. The rate of change of MPIS per hour was calculated, and differentiated responders from non-responders. After examining a histogram of ΔMPIS/h, a threshold of ΔMPIS/h > 0 was used to define response for duration of ED stay. Children included were >2 years and had initial MPIS > 10. : Eight hundred and fifty-two children were included. There were 178 (21%) non-responders and 674 (79%) responders. Non-responders were significantly older (7.0 ± 4.0 versus 5.6 ± 3.2 years; < 0.001), but there were no differences in gender, race, ethnicity or insurance status. There was also no statistical difference in time to first albuterol treatment (50 ± 41 versus 43 ± 40 min; = 0.05), or in time to corticosteroid (95 ± 75 versus 79 ± 64 min; = 0.06). Non-responders were significantly more likely to arrive by ambulance (OR 2.2; 95% CI 1.6-3.2), to be admitted to the hospital (OR 2.7; 95% CI 1.8-4.0), and to be admitted to the ICU (OR 5.0; 95% CI 3.1-8.1). : One in five children with exacerbations did not respond to treatment. These children were older and more likely to be admitted. Non-measured factors, possibly genetic, may contribute to response to treatment.
我们的目标是评估急诊科（ED）中患有中度和重度哮喘急性加重的儿童对治疗无反应的相关因素。对2014年9月至2017年2月出院诊断为哮喘急性加重的患者进行了回顾性病历审查。采用改良肺指数评分（MPIS）对疾病严重程度进行量化。计算MPIS每小时的变化率，并区分反应者和无反应者。在检查ΔMPIS/h的直方图后，使用ΔMPIS/h > 0的阈值来定义急诊留观期间的反应情况。纳入的儿童年龄大于2岁，初始MPIS > 10。共纳入852名儿童。其中178名（21%）为无反应者，674名（79%）为反应者。无反应者年龄显著更大（7.0±4.0岁对5.6±3.2岁；P < 0.001），但在性别、种族、民族或保险状况方面无差异。首次使用沙丁胺醇治疗的时间（50±41分钟对43±40分钟；P = 0.05）或使用皮质类固醇的时间（95±75分钟对79±64分钟；P = 0.06）也无统计学差异。无反应者通过救护车到达的可能性显著更高（OR 2.2；95% CI 1.6 - 3.2），住院的可能性更高（OR 2.7；95% CI 1.8 - 4.0），入住重症监护病房的可能性更高（OR 5.0；95% CI 3.1 - 8.1）。五分之一的急性加重儿童对治疗无反应。这些儿童年龄更大，且更有可能住院。可能是遗传因素等未测量的因素可能影响对治疗的反应。
