Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado and Children's Hospital Colorado, Aurora.
Department of Pediatrics, University of Colorado School of Medicine, Aurora.
JAMA Netw Open. 2020 Dec 1;3(12):e2029082. doi: 10.1001/jamanetworkopen.2020.29082.
Children with severe neurological impairment (SNI) often take multiple medications to treat problematic symptoms. However, for children who cannot self-report symptoms, no system exists to assess multiple symptoms and their association with medication use.
To assess the prevalence of 28 distinct symptoms, test whether higher global symptom scores (GSS) were associated with use of more medications, and assess the associations between specific symptoms and medications.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted between April 1, 2019, and December 31, 2019, using structured parent-reported symptom data paired with clinical and pharmacy data, at a single-center, large, hospital-based special health care needs clinic. Participants included children aged 1 to 18 years with SNI and 5 or more prescribed medications. Data analysis was performed from April to June 2020.
During routine clinical visits, parent-reported symptoms were collected using the validated 28-symptom Memorial Symptom Assessment Scale (MSAS) and merged with clinical and pharmacy data.
Symptom prevalence, counts, and GSS (scored 0-100, with 100 being the worst) were calculated, and the association of GSS with medications was examined. To evaluate associations between symptom-medication pairs, the proportion of patients with a symptom who used a medication class or specific medication was calculated.
Of 100 patients, 55.0% were boys, the median (interquartile range [IQR]) age was 9 (5-12) years, 62.0% had 3 or more complex chronic conditions, 76.0% took 10 or more medications, and none were able to complete the MSAS themselves. Parents reported a median (IQR) of 7 (4-10) concurrent active symptoms. The median (IQR) GSS was 12.1 (5.4-20.8) (range, 0.0-41.2) and the GSS was 9.8 points (95% CI, 5.5-14.1 points) higher for those with worse recent health than usual. Irritability (65.0%), insomnia (55.0%), and pain (54.0%) were the most prevalent symptoms. Each 10-point GSS increase was associated with 12% (95% CI, 4%-19%) higher medication counts, adjusted for age and complex chronic condition count. Among the 54.0% of children with reported pain, 61.0% were prescribed an analgesic.
These findings suggest that children with SNI reportedly experience substantial symptom burdens and that higher symptom scores are associated with increased medication use. Paired symptom-medication data may help clinicians identify targets for personalized symptom management, including underrecognized or undertreated symptoms.
患有严重神经功能障碍 (SNI) 的儿童通常需要服用多种药物来治疗有问题的症状。然而，对于那些无法自我报告症状的儿童，没有系统来评估多种症状及其与药物使用的关系。
评估 28 种不同症状的患病率，检验更高的总体症状评分 (GSS) 是否与使用更多药物有关，并评估特定症状与药物之间的关系。
设计、地点和参与者：这是一项横断面研究，于 2019 年 4 月 1 日至 12 月 31 日进行，使用经过验证的 28 项症状纪念症状评估量表 (MSAS) 进行了结构父母报告的症状数据与临床和药房数据配对，在一家单中心、大型、基于特殊保健需求的诊所。参与者包括年龄在 1 至 18 岁之间、SNI 且服用 5 种或以上处方药物的儿童。数据分析于 2020 年 4 月至 6 月进行。
在常规临床就诊期间，使用经过验证的 28 项症状纪念症状评估量表 (MSAS) 收集父母报告的症状，并与临床和药房数据合并。
计算了症状的患病率、计数和 GSS（评分 0-100，100 为最差），并检查了 GSS 与药物的关联。为了评估症状-药物对之间的关系，计算了有症状的患者使用药物类别或特定药物的比例。
在 100 名患者中，55.0%为男性，中位（四分位距 [IQR]）年龄为 9（5-12）岁，62.0%有 3 种或更多复杂的慢性疾病，76.0%服用 10 种或更多药物，且没有一个人能够自己完成 MSAS。父母报告了中位数（IQR）为 7（4-10）个并发活动症状。中位（IQR）GSS 为 12.1（5.4-20.8）（范围：0.0-41.2），与近期健康状况较差的患者相比，GSS 高 9.8 分（95%CI，5.5-14.1 分）。烦躁（65.0%）、失眠（55.0%）和疼痛（54.0%）是最常见的症状。GSS 每增加 10 分，与药物使用量增加 12%（95%CI，4%-19%）相关，调整年龄和复杂慢性疾病计数后。在报告有疼痛的 54.0%的儿童中，61.0%服用了镇痛药。
这些发现表明，患有 SNI 的儿童报告的症状负担很大，较高的症状评分与药物使用增加有关。配对的症状-药物数据可以帮助临床医生识别个性化症状管理的目标，包括未被认识到或治疗不足的症状。
