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Early administration of steroids in the ambulance setting: Protocol for a type I hybrid effectiveness-implementation

Jennifer N Fishe1, Phyllis Hendry2, Jennifer Brailsford3

  • 1Department of Emergency Medicine, Division of Research, University of Florida College of Medicine, Jacksonville. 655 W. 8(th) St., Jacksonville, FL 32209, United States of America; Center for Data Solutions, University of Florida College of Medicine - Jacksonville, 655 W. 11(th) St., Jacksonville, FL 32209, United States of America.

Contemporary Clinical Trials
|September 15, 2020
PubMed

Insights

Early oral systemic corticosteroids (OCS) by emergency medical services (EMS) may reduce hospitalizations for pediatric asthma exacerbations. This study investigates prehospital OCS administration to improve outcomes and identify implementation barriers.

Area of Science:

  • Emergency medicine
  • Pediatric critical care
  • Implementation science

Background:

  • Pediatric asthma exacerbations frequently necessitate emergency care.
  • Early oral systemic corticosteroids (OCS) in the emergency department (ED) reduce hospitalizations and ED length-of-stay (LOS).
  • The impact of prehospital OCS administration by emergency medical services (EMS) on pediatric asthma outcomes remains unclear.

Purpose of the Study:

  • To describe the methodology of a hybrid effectiveness-implementation trial.
  • To evaluate EMS-administered OCS for pediatric asthma exacerbations.
  • To incorporate a stepped wedge design and the RE-AIM framework.

Main Methods:

  • A non-randomized stepped wedge design will be used, with EMS agencies adopting OCS at different times.
  • Hospitalization rates, ED LOS, and short-term healthcare costs will be compared between OCS and non-OCS groups.
  • Geographic information systems (GIS) will assess outcome scaling with EMS transport time.
  • The RE-AIM framework will guide mixed methods analysis of implementation barriers and enablers, using quantitative and qualitative data.

Main Results:

  • The trial aims to determine if earlier EMS administration of OCS decreases hospitalizations, ED LOS, and healthcare costs.
  • It will assess if these outcome improvements correlate with increased EMS transport times.
  • Barriers and enablers to implementing EMS-administered OCS for pediatric asthma will be identified.

Conclusions:

  • This trial will provide crucial data on the effectiveness of prehospital OCS for pediatric asthma.
  • It will inform implementation strategies for improving emergency care for pediatric asthma exacerbations.
  • Understanding implementation factors is key to successful prehospital interventions.
Abstract

Keywords:
Pediatric asthma emergency medical services systemic corticosteroids hybrid implementation-effectiveness trial RE-AIM framework

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