TY - JOUR
T1 - Treatment patterns and frequency of key outcomes in acute severe asthma in children
T2 - A Paediatric Research in Emergency Departments International Collaborative (PREDICT) multicentre cohort study
AU - Craig, Simon
AU - Powell, Colin V.E.
AU - Nixon, Gillian M.
AU - Oakley, Ed
AU - Hort, Jason
AU - Armstrong, David S.
AU - Ranganathan, Sarath
AU - Kochar, Amit
AU - Wilson, Catherine
AU - George, Shane
AU - Phillips, Natalie
AU - Furyk, Jeremy
AU - Lawton, Ben
AU - Borland, Meredith L.
AU - O'Brien, Sharon
AU - Neutze, Jocelyn
AU - Lithgow, Anna
AU - Mitchell, Clare
AU - Watkins, Nick
AU - Brannigan, Domhnall
AU - Wood, Joanna
AU - Gray, Charmaine
AU - Hearps, Stephen
AU - Ramage, Emma
AU - Williams, Amanda
AU - Lew, Jamie
AU - Jones, Leonie
AU - Graudins, Andis
AU - Dalziel, Stuart
AU - Babl, Franz E.
N1 - Funding Information:
Funding The study was part funded by a grant from the National Health and Medical Research Council (NHMRC, Centre of Research Excellence grant (GNT1058560), Canberra, Australia and the Victorian Government’s Operational Infrastructure Support program. Data collection at Logan Hospital was supported by a grant from the Emergency Medicine Foundation, Queensland. Data collection at Perth Children’s Hospital was supported by a grant from the Perth Children’s Hospital Foundation. SC has received funding from a Thoracic Society of Australia and New Zealand/National Asthma Council Fellowship and the ACEM Foundation Al Spilman Early Career Research Grant. SRD's time is funded in part by Cure Kids New Zealand. FB’s time was part funded by a grant from the Royal Children’s Hospital Foundation, Melbourne, Victoria, Australia and an NHMRC Practitioner Fellowship.
Publisher Copyright:
© 2022 BMJ Publishing Group. All rights reserved.
PY - 2022/3/17
Y1 - 2022/3/17
N2 - Rationale Severe acute paediatric asthma may require treatment escalation beyond systemic corticosteroids, inhaled bronchodilators and low-flow oxygen. Current large asthma datasets report parenteral therapy only. Objectives To identify the use and type of escalation of treatment in children presenting to hospital with acute severe asthma. Methods Retrospective cohort study of children with an emergency department diagnosis of asthma or wheeze at 18 Australian and New Zealand hospitals. The main outcomes were use and type of escalation treatment (defined as any of intensive care unit admission, nebulised magnesium, respiratory support or parenteral bronchodilator treatment) and hospital length of stay (LOS). Measurements and main results Of 14 029 children (median age 3 (IQR 1-3) years; 62.9% male), 1020 (7.3%, 95% CI 6.9% to 7.7%) had treatment escalation. Children with treatment escalation had a longer LOS (44.2 hours, IQR 27.3-63.2 hours) than children without escalation 6.7 hours, IQR 3.5-16.3 hours; p<0.001). The most common treatment escalations were respiratory support alone (400; 2.9%, 95% CI 2.6% to 3.1%), parenteral bronchodilator treatment alone (380; 2.7%, 95% CI 2.5% to 3.0%) and both respiratory support and parenteral bronchodilator treatment (209; 1.5%, 95% CI 1.3% to 1.7%). Respiratory support was predominantly nasal high-flow therapy (99.0%). The most common intravenous medication regimens were: magnesium alone (50.4%), magnesium and aminophylline (24.6%) and magnesium and salbutamol (10.0%). Conclusions Overall, 7.3% children with acute severe asthma received some form of escalated treatment, with 4.2% receiving parenteral bronchodilators and 4.3% respiratory support. There is wide variation treatment escalation.
AB - Rationale Severe acute paediatric asthma may require treatment escalation beyond systemic corticosteroids, inhaled bronchodilators and low-flow oxygen. Current large asthma datasets report parenteral therapy only. Objectives To identify the use and type of escalation of treatment in children presenting to hospital with acute severe asthma. Methods Retrospective cohort study of children with an emergency department diagnosis of asthma or wheeze at 18 Australian and New Zealand hospitals. The main outcomes were use and type of escalation treatment (defined as any of intensive care unit admission, nebulised magnesium, respiratory support or parenteral bronchodilator treatment) and hospital length of stay (LOS). Measurements and main results Of 14 029 children (median age 3 (IQR 1-3) years; 62.9% male), 1020 (7.3%, 95% CI 6.9% to 7.7%) had treatment escalation. Children with treatment escalation had a longer LOS (44.2 hours, IQR 27.3-63.2 hours) than children without escalation 6.7 hours, IQR 3.5-16.3 hours; p<0.001). The most common treatment escalations were respiratory support alone (400; 2.9%, 95% CI 2.6% to 3.1%), parenteral bronchodilator treatment alone (380; 2.7%, 95% CI 2.5% to 3.0%) and both respiratory support and parenteral bronchodilator treatment (209; 1.5%, 95% CI 1.3% to 1.7%). Respiratory support was predominantly nasal high-flow therapy (99.0%). The most common intravenous medication regimens were: magnesium alone (50.4%), magnesium and aminophylline (24.6%) and magnesium and salbutamol (10.0%). Conclusions Overall, 7.3% children with acute severe asthma received some form of escalated treatment, with 4.2% receiving parenteral bronchodilators and 4.3% respiratory support. There is wide variation treatment escalation.
KW - paediatric asthma
UR - http://www.scopus.com/inward/record.url?scp=85126723691&partnerID=8YFLogxK
U2 - 10.1136/bmjresp-2021-001137
DO - 10.1136/bmjresp-2021-001137
M3 - Article
C2 - 35301198
AN - SCOPUS:85126723691
SN - 2052-4439
VL - 9
JO - BMJ Open Respiratory Research
JF - BMJ Open Respiratory Research
IS - 1
M1 - e001137
ER -