Department of Respiratory & Sleep Medicine, Queensland Children's Hospital, Queensland, Australia.
Department of Paediatric Medicine, School of Medicine, University of Queensland, Queensland, Australia.
Pediatr Pulmonol. 2020 Apr;55(4):994-999. doi: 10.1002/ppul.24670. Epub 2020 Feb 18.
Children with bronchiectasis have recurrent exacerbations and may require hospitalization. "Hospital in the home (HITH)" is used as an alternative to hospitalization for children with cystic fibrosis (CF) but to date, there is no published data on children without CF. We describe our experience of HITH (intravenous [IV] antibiotics and at least once-daily physiotherapy-treated airway clearance therapy) in a cohort of children with bronchiectasis, comparing outcomes between hospital and HITH-based pathways.
Medical records were retrospectively reviewed in children with bronchiectasis who were hospitalized in our center from July 2016 to July 2018. We compared treatment duration, symptom resolution, adverse events, oral antibiotic prescription on discharge and "time-to-next hospitalization" between children managed with the two treatment pathways.
Exacerbations in 63 children (median age = 6 years [range: 1-17]; females = 33, indigenous = 8) with bronchiectasis treated with IV antibiotic therapy were analyzed (HITH n = 45, 71.5%). Duration of treatment and symptom resolution was similar between groups (hospital: median = 14 days [interquartile range {IQR}: 14-14] and 12/18 [66.6%], respectively vs HITH: 14 [14-15.5] and 31/45 [69%]; P = .53 and .85, respectively). There was no significant difference in adverse events (16.6% vs 9%), prescription of oral antibiotics on discharge (44% vs 24%), or "time-to-next hospitalization" (median 42 [IQR: 24-100] vs 67 [IQR: 32-95] weeks) between hospital and HITH groups, respectively.
In children with bronchiectasis treated for a severe exacerbation, receiving treatment in the home setting with HITH does not compromise short-term clinical outcomes compared to hospital only treatment. Prospective studies are required to provide more robust evidence in this under-researched area.
患有支气管扩张症的儿童会反复发作，可能需要住院治疗。“家庭医院（HITH）”被用作囊性纤维化（CF）儿童的住院替代治疗方法，但迄今为止，尚无针对非 CF 儿童的相关数据。我们描述了在支气管扩张症患儿中使用 HITH（静脉内[IV]抗生素和至少每日一次的物理治疗气道清除治疗）的经验，并比较了住院和基于 HITH 的治疗途径的结果。
回顾性分析了 2016 年 7 月至 2018 年 7 月期间在我院住院的支气管扩张症患儿的病历。我们比较了两组患儿的治疗持续时间、症状缓解、不良事件、出院时口服抗生素处方以及“下次住院时间”。
共分析了 63 例（中位年龄 6 岁[范围：1-17]；女性 33 例，土著 8 例）接受 IV 抗生素治疗的支气管扩张症加重患儿（HITH 组 45 例，71.5%）。两组患儿的治疗持续时间和症状缓解时间相似（住院组：中位数 14 天[四分位距 {IQR}：14-14]和 18/18[66.6%]，分别 vs HITH 组：14 天[14-15.5]和 31/45[69%]；P=0.53 和.85，分别）。两组患儿的不良事件发生率（16.6% vs 9%）、出院时口服抗生素处方率（44% vs 24%）或“下次住院时间”（中位数 42[IQR：24-100] vs 67[IQR：32-95]周）均无显著差异。
在因严重加重而接受治疗的支气管扩张症患儿中，与仅住院治疗相比，在家中接受 HITH 治疗不会影响短期临床结局。需要前瞻性研究为这一研究不足的领域提供更有力的证据。
