Medical College of Wisconsin, Children's Wisconsin, Milwaukee, Wisconsin,
Medical College of Wisconsin, Children's Wisconsin, Milwaukee, Wisconsin.
WMJ. 2022 Apr;121(1):30-35.
Dexamethasone use for pediatric asthma exacerbations in the emergency department is supported in literature as a beneficial alternative to prednisone; however, there is limited data in the hospital setting. This study assesses factors that influence pediatric hospital providers' steroid choice for patients hospitalized for status asthmaticus.
A survey was developed to assess factors influencing steroid prescribing practices. It was completed by our institution's pediatric hospitalists and advance practice providers in June 2019 and April 2021. Responses were summarized using descriptive statistics, interrater agreement was analyzed with Cohen's kappa statistic, and bivariate comparisons were analyzed with chi-square tests.
Thirty-six of 39 providers completed the survey in 2019; 31 of 43 completed it in 2021. They reported wide disagreement with the use of dexamethasone in both surveys (2019 vs 2021: 34% vs 55% in favor, 43% vs 35% neutral, 23% vs 9% opposing, = 0.191). There was a self-reported increase in prescribing frequency of dexamethasone from 2019 to 2021 ( = 0.007). There was moderate agreement with prescribing dexamethasone for patients with poor oral tolerance or medication noncompliance (2019: κ = 0.485, = 0.002; 2021: κ = 0.281, = 0.048). There was moderate agreement with prescribing prednisone for patients with higher severity of baseline asthma or current exacerbation (2019: κ = 0.537, < 0.001; 2021: κ = 0.500, < 0.001). Length of the dexamethasone course did not influence prescribing practices ( > 0.05).
In our inpatient setting, prednisone is preferred for severe asthma cases, while dexamethasone is preferred for patients with poor oral tolerance or medication noncompliance. The length of the dexamethasone course did not influence providers' steroid choice.
文献支持在急诊科使用地塞米松治疗小儿哮喘发作作为泼尼松的有益替代方案；然而，在医院环境中数据有限。本研究评估了影响儿科医院医生为因哮喘持续状态住院的患者选择类固醇药物的因素。
我们开发了一项调查来评估影响类固醇处方实践的因素。该调查于 2019 年 6 月和 2021 年 4 月由我们机构的儿科医院医生和高级执业医师完成。使用描述性统计数据总结了调查结果，使用 Cohen's kappa 统计分析了评分者间一致性，并使用卡方检验进行了双变量比较。
39 名提供者中有 36 名在 2019 年完成了调查；43 名中有 31 名在 2021 年完成了调查。他们报告说，在这两项调查中都对地塞米松的使用存在广泛的分歧（2019 年 vs 2021 年：赞成者分别为 34%和 55%，中立者分别为 43%和 35%，反对者分别为 23%和 9%，=0.191）。自我报告的地塞米松处方频率从 2019 年到 2021 年有所增加（=0.007）。对于口服耐受性差或药物不依从的患者，处方地塞米松具有中度一致性（2019 年：κ=0.485，=0.002；2021 年：κ=0.281，=0.048）。对于基线哮喘严重程度较高或当前加重的患者，处方泼尼松具有中度一致性（2019 年：κ=0.537，<0.001；2021 年：κ=0.500，<0.001）。地塞米松疗程的长短并不影响处方实践（>0.05）。
在我们的住院环境中，对于严重哮喘病例，首选泼尼松，而对于口服耐受性差或药物不依从的患者，首选地塞米松。地塞米松疗程的长短并不影响医生选择类固醇药物。
