Walsh Patrick S, Zhang Yin, Lipshaw Matthew J
Section of Pediatric Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.
Divisions of Biostatistics and Epidemiology.
Hosp Pediatr. 2023 Feb 1;13(2):167-173. doi: 10.1542/hpeds.2022-006905.
Racemic epinephrine (RE) is commonly administered for croup in the emergency department (ED). Our objectives were to examine variation in RE use between EDs, to determine whether ED variation in RE use is associated with hospital or patient factors, and to evaluate the associations between the rates of hospital-specific ED RE use and patient outcomes.
We performed a retrospective cohort study using the Pediatric Heath Information System of children aged 3 months to 10 years with croup in the ED. We used mixed-effects regression to calculate risk-standardized proportions of patients receiving RE in each ED and to analyze the relationship between risk-standardized institutional RE use and individual patient odds of hospital admission, ICU admission, and ED revisits.
We analyzed 231 683 patient visits from 39 hospitals. ED administration of RE varied from 14% to 48% of visits (median, 24.5%; interquartile range, 20.0%-27.8%). A total of 8.6% of patients were hospitalized and 1% were admitted to the ICU. After standardizing for case mix and site effects, increasing ED use of RE per site was associated with increasing patient odds of hospital admission (odds ratio [OR], 1.39-95%; confidence interval [CI], 1.01-1.91), but not ICU admission (OR, 1.39; 95% CI, 0.99-1.97) or ED revisit (OR, 1.00; 95% CI, 0.92-1.09).
In this large, observational study, RE administration varied widely across EDs. Increased RE use by site was associated with increased odds of hospital admission for individual patients when controlling for patient factors. These results suggest further standardization of RE use in children with croup is warranted.
消旋肾上腺素（RE）常用于急诊科（ED）治疗哮吼。我们的目的是研究各急诊科之间RE使用的差异，确定急诊科RE使用的差异是否与医院或患者因素相关，并评估医院特定急诊科RE使用率与患者结局之间的关联。
我们使用儿科健康信息系统对急诊科3个月至10岁患哮吼的儿童进行了一项回顾性队列研究。我们使用混合效应回归来计算每个急诊科接受RE治疗患者的风险标准化比例，并分析风险标准化机构RE使用与患者住院、入住重症监护病房（ICU）和再次就诊的个体几率之间的关系。
我们分析了来自39家医院的231683例患者就诊情况。急诊科RE的使用率在就诊患者的14%至48%之间（中位数为24.5%；四分位间距为20.0%-27.8%）。共有8.6%的患者住院，1%的患者入住ICU。在对病例组合和地点效应进行标准化后，每个地点急诊科RE使用量的增加与患者住院几率的增加相关（比值比[OR]为1.39；95%置信区间[CI]为1.01-1.91），但与入住ICU（OR为1.39；95%CI为0.99-1.97）或再次就诊（OR为1.00；95%CI为0.92-1.09）无关。
在这项大型观察性研究中，各急诊科之间RE的使用差异很大。在控制患者因素时，各地点RE使用量的增加与个体患者住院几率的增加相关。这些结果表明，哮吼患儿RE的使用有必要进一步标准化。
