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Stress Ulcer Prophylaxis for Critical Asthma
Alexa Rae Roberts1, Meghan Roddy2, Michael John Wilsey3
1Divisions of General Pediatrics and Adolescent Medicine.
Insights
Pediatric intensive care unit (PICU) patients with critical asthma (CA) often receive stress ulcer prophylaxis (SUP), but this study found no gastrointestinal bleeding events. SUP use increased over time, suggesting a need for targeted prophylaxis based on actual bleeding risk factors.
Area of Science:
- Pediatric Critical Care Medicine
- Pharmacology
- Gastroenterology
Background:
- Children hospitalized for critical asthma (CA) in the pediatric intensive care unit (PICU) are frequently prescribed stress ulcer prophylaxis (SUP).
- This practice aims to prevent gastrointestinal (GI) bleeding, a potential complication in critically ill children.
- However, the actual benefit and necessity of routine SUP in this population warrant investigation.
Purpose of the Study:
- To analyze trends in stress ulcer prophylaxis (SUP) prescribing for children with critical asthma (CA) admitted to the pediatric intensive care unit (PICU).
- To compare the incidence of GI bleeding, gastritis, and SUP-related complications between children who received SUP and those who did not.
- To evaluate the appropriateness of SUP use in this specific pediatric patient group.
Main Methods:
- A retrospective, multicenter cohort study was conducted using data from the Pediatric Hospital Information System registry (2010-2019).
- The study included children aged 3-17 years admitted to the PICU for CA across 42 children's hospitals.
- Joinpoint regression and Pearson's correlation were used to assess temporal and regional prescribing variations, alongside comparisons of clinical outcomes between SUP-exposed and non-exposed groups.
Main Results:
- Out of 30,177 children studied, 34.4% received stress ulcer prophylaxis (SUP).
- No gastrointestinal bleeding episodes were recorded; one case of gastric ulceration and 32 cases of gastritis (0.1%) were observed.
- SUP prescribing rates increased linearly from 25.5% in 2010 to 42.1% in 2019, with significant institutional variation and rare SUP-related complications.
Conclusions:
- Despite routine stress ulcer prophylaxis (SUP) use in critically ill asthmatic children, gastrointestinal bleeding was not observed over a decade.
- SUP solely for corticosteroid exposure may be unnecessary in this patient cohort.
- A more targeted approach to SUP, considering specific risk factors for GI bleeding, is recommended.
Background:
Children hospitalized for critical asthma (CA) in the pediatric ICU (PICU) are commonly prescribed stress ulcer prophylaxis (SUP) to mitigate risk of gastrointestinal (GI) bleeding. We sought to describe trends for SUP prescribing and explore for differences in rates of GI bleeding, gastritis, and SUP-related complications for those with and without SUP exposure.
Methods:
We performed a retrospective, multicenter cohort study using the Pediatric Hospital Information System registry among 42 children's hospitals from 2010 to 2019 including children 3 to 17 years of age admitted to the PICU for CA. Primary outcomes were chronologic and regional variation in SUP prescribing assessed by Joinpoint regression and Pearson's correlation. Rates of GI bleeding, gastritis, enteric ulceration, and SUP-related complications (C. difficile colitis, necrotizing enterocolitis, and thrombocytopenia) were compared for those with and without SUP exposure.
Results:
Of 30 177 children studied, 10 387 (34.4%) received SUP. No episodes of GI bleeding were recorded. One subject developed gastric ulceration and 32 (0.1%) gastritis. Linear trends for SUP were observed with rates increasing from 25.5% in 2010 to 42.1% in 2019 (+1.9% annually). Prescribing varied by institution (range: 5.5% to 97.2%) without correlation to admission volumes. Extremely rare rates of SUP-related complications were noted.
Conclusions:
Although children hospitalized for CA routinely receive SUP, no episodes of GI bleeding were noted over a 10-year period. SUP solely for corticosteroid exposure may be unwarranted. We advocate for a targeted approach to SUP considering alternative risk factors for GI bleeding.
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