给儿科喘患者使用EMS系统性皮质类固醇:根据严重程度和运输间隔进行分析
Lauren Riney1, Sam Palmer2, Erik Finlay2
1Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Prehospital emergency care
|July 10, 2023
概括
紧急医疗服务 (EMS) 对儿科喘患者系统性皮质类固醇的使用并没有显著减少整体住院病例. 然而,在轻度恶化和更长的运输间隔中观察到潜在的益处.
科学领域:
- 儿科急救医学 儿科急救医学
- 药理学 药理学是指药理学的学科.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 儿童喘恶化经常导致紧急医疗服务 (EMS) 的遭遇.
- 支气管扩展剂和全身皮质类固醇是标准的治疗方法,但它们在通过EMS给予时的疗效仍在争论中.
- 现有的关于儿童在医院前系统性皮质类固醇的有效性数据不一致.
研究的目的:
- 评估EMS对儿科喘患者系统性皮质类固醇的管理与住院率之间的关联.
- 根据喘恶化的严重程度和EMS运输间隔来分析这种关联.
主要方法:
- 在救护车环境中早期服用类固醇的子分析:观察性设计试验 (EASI AS ODT).
- 包括841名儿科患者 (年龄在2-18岁) 经证实喘恶化,由7个EMS机构治疗.
- 使用单变量分析比较住院率,考虑恶化的严重程度和运输时间.
主要成果:
- 总的来说,82.3%的人接受了吸入式支气管扩展剂,但只有21%的人接受了全身性皮质类固醇.
- 在接受 (33%) 和不接受 (32%) EMS 系统性皮质类固醇的患者之间,住院率没有显著差异.
- 不具有统计学意义的趋势显示,在特定子组中,EMS系统性皮质类固醇使用的住院病例减少 (轻度为11%,运输时间超过40分钟为16%).
结论:
- 在这项研究中,EMS系统性皮质类固醇的使用并没有减少儿童喘住院的总体情况.
- 潜在的益处可能存在于子组,包括患有轻度恶化或较长EMS输送间隔 (>40分钟) 的患者.
- 在制定儿科喘管理方案时,EMS机构应考虑当地因素.
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