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Serum theophylline testing in a pediatric emergency setting: potential benefit of rapid assays
K N Shaw1, G R Fleisher, J S Schwartz
1Department of Pediatrics, Children's Hospital of Philadelphia, PA 19104.
Insights
Rapid theophylline assays can improve asthma care for children in emergency departments. Faster results lead to more accurate dosing and shorter emergency visits, benefiting pediatric patients.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Pharmacology
- Respiratory Medicine
Background:
- Theophylline is a common asthma medication for children.
- Current monitoring practices for theophylline therapy in pediatric emergency departments are often suboptimal.
- The adequacy of theophylline therapy and emergency department visit duration are key outcome measures.
Purpose of the Study:
- To assess the clinical benefit of rapid theophylline assays in a pediatric emergency setting.
- To examine current practices in monitoring and adjusting theophylline therapy for pediatric asthma patients.
- To determine the relationship between current practices, therapy adequacy, and emergency department visit duration.
Main Methods:
- Prospective study of wheezing children taking theophylline in an urban pediatric emergency department.
- Analysis of theophylline level monitoring, dosage adjustments, and treatment outcomes.
- Comparison of outcomes with and without the administration of intravenous theophylline therapy.
Main Results:
- Theophylline levels were not obtained for 52% of eligible children, despite dosage adjustments in 38%.
- For patients receiving intravenous theophylline, 83% were treated before results were available (average wait: 1 hour 48 minutes).
- Suboptimal theophylline doses (12% excessive, 57% inadequate) were common, leading to prolonged emergency department stays.
Conclusions:
- Rapid theophylline immunoassays offer potential to enhance the management of acute pediatric asthma.
- Improved accuracy in theophylline dosing can be achieved with faster assay results.
- Decreasing the duration of emergency department visits is a significant potential benefit of rapid assays.
Abstract:
This study assessed the potential clinical benefit of rapid theophylline assays in an urban pediatric emergency department by 1) examining current practices of monitoring and adjusting theophylline therapy in children with asthma and 2) determining the relationship between these practices and the adequacy of theophylline therapy and duration of emergency department visits. Of 213 consecutive wheezing children who reported taking theophylline, levels were not obtained on 114 (52%), even though theophylline dosages were adjusted for 43 (38%). Of the 99 patients who had theophylline levels drawn, 80 were successfully enrolled in the study. Most children who received intravenous theophylline therapy 1) were treated prior to availability of serum theophylline results (83%), which took an average of one hour and 48 minutes, and 2) received suboptimal doses (12% were excessive, and 57% were inadequate). The latter patients were more likely to require additional intravenous theophylline that prolonged their stay in the emergency department. If intravenous theophylline therapy was not administered, the wait for the theophylline level was longer than the visit itself. These findings indicate that rapid immunoassays for theophylline have the potential to improve management of children with acute asthma in an emergency department by improving the accuracy of dosing and decreasing the duration of stay.