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Published on: March 6, 2019
Multicentre study revealed significant gaps between evidence-based recommendations for using corticosteroids for
Luca Pierantoni1, Giacomo Stera2, Laura Andreozzi1
1Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Insights
Treatment for croup in pediatric emergency departments shows poor adherence to guidelines. Improving adherence could significantly reduce costs and improve patient outcomes.
Area of Science:
- Pediatric Emergency Medicine
- Pharmacology
- Clinical Practice Guidelines
Background:
- Adherence to established croup management recommendations is not well-understood.
- Pediatric emergency departments face challenges in consistently applying evidence-based treatment protocols for croup.
Purpose of the Study:
- To investigate current treatment patterns for croup in two Italian pediatric emergency departments.
- To assess adherence to clinical recommendations for croup management.
- To analyze the economic impact of current treatment practices versus recommended guidelines.
Main Methods:
- Retrospective chart review of pediatric patients diagnosed with croup in 2017.
- Data collection included clinical presentation, corticosteroid administration (inhaled and oral), and home therapy.
- Comparison of length of stay, hospitalization, and re-access rates across different treatment groups.
Main Results:
- 632 pediatric patients were included; 63.8% received corticosteroids in the emergency department.
- Dexamethasone was rarely used (0.4%). Inhaled and oral corticosteroids were common, as was home therapy.
- Pharmaceutical costs were estimated to be 10 times higher than if recommendations were followed, with a 2.8% re-access rate.
Conclusions:
- A notable discrepancy exists between evidence-based recommendations and actual clinical practice in croup treatment.
- Enhanced adherence to croup management guidelines can yield significant clinical and economic advantages.
- Optimizing corticosteroid use and administration routes could improve efficiency and reduce healthcare expenditure.
Aim:
Adherence to croup management recommendations has been poorly investigated. This study aimed to describe the treatment patterns in two paediatric emergency departments and analyse the adherence to recommendations.
Methods:
We conducted a retrospective chart review of children diagnosed with croup in two Italian paediatric emergency departments in 2017. Data on clinical presentation, corticosteroid administration and home therapy were collected. Length of stay, hospitalisation and re-access rates were compared among different corticosteroid treatment groups.
Results:
We enrolled 632 patients (61.1% males) with a mean age of 42.8 ± 55.1 months. Corticosteroids were administered to 403 (63.8%) children in the emergency departments. Dexamethasone was administered to 1 (0.4%) patient. Inhaled and oral corticosteroids were given to 342 (54.1%) and 226 (35.8%) patients, respectively. Home therapy was prescribed for 603 (95.4%) patients, either with inhaled (86.2%) and/or oral (43.8%) corticosteroids. The re-access rate was 2.8%. The actual pharmaceutical costs were an estimated 10 times higher than they would have been if the recommendations had been followed.
Conclusion:
A significant gap between the evidence and clinical practice for croup treatment was observed. Improving adherence to the recommendations could lead to clinical and economic benefits.
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