在救护车环境中早期服用类固醇:观察性设计试验 (EASI-AS-ODT)
Jennifer N Fishe1,2, Gerard Garvan2, Andrew Bertrand1
1Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA.
概括
紧急医疗服务 (EMS) 对儿科喘恶化进行的全身性皮质类固醇的医院前管理显著增加,但没有降低住院率. 需要进一步的研究来优化EMS协议以获得更好的患者结果.
科学领域:
- 紧急医疗 紧急医疗
- 儿科重症监护中心儿童重症监护中心
- 呼吸系统医学 呼吸系统医学
背景情况:
- 在急诊室 (ED) 及时的全身皮质类固醇管理减少了儿童喘的入院.
- 在ED到来之前,紧急医疗服务 (EMS) 早期使用皮质类固醇的好处的证据有限.
研究的目的:
- 评估医院前口服系统性皮质类固醇 (OCS) 通过EMS对儿童喘恶化住院率的影响.
- 在多中心观察研究中评估EMS皮质类固醇使用与儿科喘结果之间的关联.
主要方法:
- 一个多中心的,观察性的,阶梯式形设计研究,涉及七个EMS机构.
- 对比儿童喘患者 (2-18岁) 实施医院前OCS协议之前和之后的住院率和ED停留时间.
- 利用单变量分析和多变量混合效应模型来分析数据.
主要成果:
- 在协议实施后,OCS的EMS管理从14.7%增加到28.1% (p < 0.001).
- 在OCS引入之前和之后的住院率或ED停留时间长度中没有发现显著差异.
- 在接受EMS皮质类固醇和不接受EMS皮质类固醇的患者之间,没有发现结果的显著差异.
结论:
- 在EMS中实施OCS协议显著增加了对儿科喘的医院前皮质类固醇的使用,但没有降低住院率.
- 低整体率的EMS系统性皮质类固醇的管理表明需要进一步调查的最佳实施策略.
- 需要进行额外的研究,以确定如何最好地实施EMS协议更改,以改善儿科喘结果.
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