急救医疗服务系统中全身皮质类固醇对儿科哮喘患者的应用：基于严重程度和转运时间的分析。
EMS Administration of Systemic Corticosteroids to Pediatric Asthma Patients: An Analysis by Severity and Transport Interval.
机构信息
Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
University of Florida GeoPlan Center, Gainesville, Florida.
出版信息
Prehosp Emerg Care. 2023;27(7):900-907. doi: 10.1080/10903127.2023.2234996. Epub 2023 Jul 28.
INTRODUCTION
Pediatric asthma exacerbations are a common cause of emergency medical services (EMS) encounters. Bronchodilators and systemic corticosteroids are mainstays of asthma exacerbation therapy, yet data on the efficacy of EMS administration of systemic corticosteroids are mixed. This study's objective was to assess the association between EMS administration of systemic corticosteroids to pediatric asthma patients on hospital admission rates based on asthma exacerbation severity and EMS transport intervals.
METHODS
This is a sub-analysis of the Early Administration of Steroids in the Ambulance Setting: An Observational Design Trial (EASI AS ODT). EASI AS ODT is a non-randomized, stepped wedge, observational study examining outcomes one year before and one year after seven EMS agencies incorporated an oral systemic corticosteroid option into their protocols for the treatment of pediatric asthma exacerbations. We included EMS encounters for patients ages 2-18 years confirmed by manual chart review to have asthma exacerbations. We compared hospital admission rates across asthma exacerbation severities and EMS transport intervals using univariate analyses. We geocoded patients and created maps to visualize the general trends of patient characteristics.
RESULTS
A total of 841 pediatric asthma patients met inclusion criteria. While most patients were administered inhaled bronchodilators by EMS (82.3%), only 21% received systemic corticosteroids, and only 19% received both inhaled bronchodilators and systemic corticosteroids. Overall, there was no significant difference in hospitalization rates between patients who did and did not receive systemic corticosteroids from EMS (33% vs. 32%, = 0.78). However, although not statistically significant, for patients who received systemic corticosteroids from EMS, there was an 11% decrease in hospitalizations for mild exacerbation patients and a 16% decrease in hospitalizations for patients with EMS transport intervals greater than 40 min.
CONCLUSION
In this study, systemic corticosteroids were not associated with a decrease in hospitalizations of pediatric patients with asthma overall. However, while limited by small sample size and lack of statistical significance, our results suggest there may be a benefit in certain subgroups, particularly patients with mild exacerbations and those with transport intervals longer than 40 min. Given the heterogeneity of EMS agencies, EMS agencies should consider local operational and pediatric patient characteristics when developing standard operating protocols for pediatric asthma.
介绍
儿科哮喘发作是急诊医疗服务（EMS）的常见原因。支气管扩张剂和全身皮质类固醇是哮喘发作治疗的主要方法，然而关于 EMS 给予全身皮质类固醇治疗哮喘发作的疗效的数据喜忧参半。本研究的目的是根据哮喘发作严重程度和 EMS 转运时间评估 EMS 给予儿科哮喘患者全身皮质类固醇与住院率之间的关系。
方法
这是早期在救护车上给予皮质类固醇的观察性设计试验（EASI AS ODT）的亚分析。EASI AS ODT 是一项非随机、逐步楔形、观察性研究，在七个 EMS 机构将口服全身皮质类固醇纳入其儿科哮喘发作治疗方案一年前后，检查结果。我们纳入了通过手动图表审查确认为哮喘发作的年龄在 2-18 岁之间的 EMS 就诊患者。我们使用单变量分析比较了不同哮喘发作严重程度和 EMS 转运时间的住院率。我们对患者进行地理编码并创建地图，以可视化患者特征的总体趋势。
结果
共有 841 名儿科哮喘患者符合纳入标准。虽然大多数患者在 EMS 接受了吸入性支气管扩张剂（82.3%），但只有 21%接受了全身皮质类固醇，只有 19%接受了吸入性支气管扩张剂和全身皮质类固醇。总体而言，从 EMS 接受和未接受全身皮质类固醇的患者之间的住院率没有显著差异（33%比 32%，=0.78）。然而，尽管没有统计学意义，但对于从 EMS 接受全身皮质类固醇的患者，轻度发作患者的住院率下降了 11%，转运时间超过 40 分钟的患者的住院率下降了 16%。
结论
在这项研究中，全身皮质类固醇与儿科哮喘患者的整体住院率降低无关。然而，尽管受到样本量小和缺乏统计学意义的限制，我们的结果表明，在某些亚组中可能存在益处，特别是轻度发作的患者和转运时间超过 40 分钟的患者。鉴于 EMS 机构的异质性，EMS 机构在制定儿科哮喘的标准操作协议时应考虑当地的操作和儿科患者特征。
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