Reducing oral steroid intolerability and drug costs for acute wheezers: a retrospective evaluation of a clinical management algorithm in a Pediatric Emergency Department

Gail Davison*, Josh Ruddell, Michelle Trouton, Roisin McDonald, Ben Kennedy, Vikki O'Neill, Joseph McCann, Brigitte Bartholome, Heather Steen, Mike D. Shields, Stephen Mullen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

Project Aim
To retrospectively evaluate a clinical management algorithm for acute wheezers in a UK Pediatric Emergency Department (PED).

Overview and Rationale
Acute wheezing attacks are a leading cause of PED attendances and inpatient admissions. Prednisolone, a routine treatment, is intolerable in almost one-third of children, requiring repeated dosing, which may prolong length of stay (LOS). To address this problem, we: (1) developed an acute management algorithm (concise, single-sided flow-chart, instructing immediate management); (2) modified the OCS regime from prednisolone (1 mg/kg, 3-day course) to dexamethasone (600 then 300 mcg/kg); (3) and disseminated guidance regionally. Written information—handouts, e-mails, and posters—were followed-up with verbal reinforcement. We implemented the algorithm in 2017 and revised it further in 2018.

Evaluation
In 2019, we retrospectively collected data on 100 acute wheeze attendances (those requiring OCS, aged 2–14), between October and December in 2016, 2017, and 2018 (n = 300), and assessed outcomes.

Results
Over a 48-month period, we reduced OCS intolerability by 67.2% and OCS drug costs by 85.8% (saving £41,470.14), while not significantly influencing the other outcomes.

Conclusions
Reduced intolerability and substantial cost savings can be achieved by implementing a structured acute pediatric wheeze algorithm and modifying the OCS to single-dose dexamethasone (300 mcg/kg).

Original languageEnglish
Pages (from-to)1012-1021
Number of pages10
JournalPediatric Pulmonology
Volume58
Issue number4
Early online date13 Jan 2023
DOIs
Publication statusPublished - Mar 2023

Keywords

  • asthma
  • children
  • steroids

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