Multicentre study revealed significant gaps between evidence-based recommendations for using corticosteroids for...

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.