静脉注射地塞米松在脓毒性关节炎住院儿童中的应用及结局

Intravenous Dexamethasone Use and Outcomes in Children Hospitalized With Septic Arthritis.

作者信息

Kern-Goldberger Andrew S, Hall Matthew, Mestre Marcos, Markham Jessica L, Wang Marie E, Goenka Pratichi K, Brower Laura H, Payson Alison, Villani Mary, Rice Denning Jaime, Shah Samir S

机构信息

Division of Pediatric Hospital Medicine, Cleveland Clinic Children's Hospital and Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio.

Children's Hospital Association, Lenexa, Kansas.

出版信息

Hosp Pediatr. 2025 May 1;15(5):369-377. doi: 10.1542/hpeds.2024-008047.

DOI:10.1542/hpeds.2024-008047

PMID:40189216

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12210227/

Abstract

BACKGROUND

Septic arthritis is routinely treated with joint drainage and antibiotics; however, adjunctive systemic corticosteroids may improve outcomes.

OBJECTIVES

To (1) describe variation in intravenous dexamethasone use and (2) evaluate the association of intravenous dexamethasone use with outcomes among children hospitalized with septic arthritis.

METHODS

This is a retrospective cohort study of hospitalized children using the Pediatric Health Information System database. We identified intravenous dexamethasone use (on hospital days 0-2) in children with an International Classification of Diseases, Tenth Revision discharge code for septic arthritis (M00.x). The primary outcome was hospital length of stay (LOS). Secondary outcomes included costs, postdrainage imaging, opioid use, repeat drainage procedures, and 30-day emergency department or hospital revisits. We used propensity score matching to account for measured differences between dexamethasone recipients and nonrecipients.

RESULTS

We identified 3524 hospitalizations across 47 hospitals from 2016 to 2020. The median rate of dexamethasone use across hospitals was 28% (IQR, 19%-44%). In the propensity-matched cohort, dexamethasone was associated with shorter LOS (100.5 vs 114.3 hours, P < .001) and lower costs ($16 660 vs $18 243, P = .01) but greater opioid use (odds ratio [OR], 3.80; 95% CI, 1.49-9.70; P < .01). There were no significant differences in 30-day revisits (OR, 0.97; 95% CI, 0.73-1.29; P = .84), postdrainage computed tomography or magnetic resonance imaging (OR, 0.91; 95% CI, 0.71-1.15; P = .42), or repeat drainage procedures (OR, 1.01; 95% CI, 0.81-1.25; P = .94).

CONCLUSION

In this large cohort study, children with septic arthritis receiving dexamethasone had shorter hospital LOS and costs without higher 30-day revisit rates. Dexamethasone use varied widely across hospitals. These findings highlight the need for evaluation in a multicenter randomized trial.

摘要

背景

化脓性关节炎通常采用关节引流和抗生素治疗；然而，辅助全身性皮质类固醇可能会改善治疗结果。

目的

（1）描述静脉注射地塞米松的使用差异；（2）评估静脉注射地塞米松的使用与化脓性关节炎住院儿童治疗结果之间的关联。

方法

这是一项利用儿科健康信息系统数据库对住院儿童进行的回顾性队列研究。我们在患有国际疾病分类第十版（ICD-10）出院诊断码为化脓性关节炎（M00.x）的儿童中确定了静脉注射地塞米松的使用情况（在住院第0至2天）。主要结局是住院时间（LOS）。次要结局包括费用、引流后影像学检查、阿片类药物使用、重复引流操作以及30天内急诊或再次住院情况。我们使用倾向评分匹配来解释地塞米松接受者和非接受者之间的测量差异。

结果

我们确定了2016年至2020年期间47家医院的3524例住院病例。各医院地塞米松的使用中位数率为28%（四分位间距，19%-44%）。在倾向评分匹配队列中，地塞米松与较短的住院时间（100.5小时对114.3小时，P < 0.001）和较低的费用（16660美元对18243美元，P = 0.01）相关，但阿片类药物使用更多（比值比[OR]，3.80；95%置信区间，1.49-9.70；P < 0.01）。30天内再次住院（OR，0.97；95%置信区间，0.73-1.29；P = 0.84）、引流后计算机断层扫描或磁共振成像（OR，0.91；95%置信区间，0.71-1.15；P = 0.42）或重复引流操作（OR，1.01；95%置信区间，0.81-1.25；P = 0.94）方面无显著差异。