哮喘联盟

   摘要
   目的：研究不需要重症监护的哮喘急性加重住院儿童使用地塞米松vs.强的松/强的松龙的疗效比较。
   试验设计：本多中心回顾性队列研究使用儿童健康信息系统，对2007.1.1-2012.12.31期间主要诊断为哮喘的4-17岁住院儿童进行研究。剔除患有复杂慢性疾病和/或最初重症监护（ICU）治疗的儿童。采用倾向评分匹配检测两组在住院时间（LOS）、再入院、ICU转入和花费方面的差异。
   结果：共40257例住院儿童符合纳入标准；1166例(2.9%)只接受地塞米松治疗。在对比研究队列（N = 1284，来自34家医院），地塞米松组的LOS显著短于强的松/强的松龙组。地塞米松组LOS≥3天的比例为6.7%，而强的松/强的松龙组为12%(P =0 .002)。在7-30天全因再入院方面两组无显著差异。地塞米松组的指数入院($2621 vs $2838; P <0 .001)和总护理事件($2624 vs $2856; P < 0.001)的花费显著低于强的松/强的松龙组。两组在ICU转入或再入院方面无临床显著差异。
   结论：地塞米松可以作为强的松/强的松龙的备选，治疗不需要重症监护的哮喘急性加重住院儿童。 
 

（苏欣 审校）
J Pediatr. 2015 Sep;167(3):639-644.e1. doi: 10.1016/j.jpeds.2015.06.038.

 

Comparative Effectiveness of Dexamethasone versus Prednisone in Children Hospitalized with Asthma.
 

Parikh K1, Hall M2, Mittal V3, Montalbano A4, Gold J5, Mahant S6, Wilson KM7, Shah SS8.
 

Abstract
OBJECTIVES:To study the comparative effectiveness of dexamethasone vs prednisone/prednisolone in children hospitalized with asthma exacerbation not requiring intensive care.
STUDY DESIGN:This multicenter retrospective cohort study, using the Pediatric Health Information System, included children aged 4-17 years who were hospitalized with a principal diagnosis of asthma between January 1, 2007 and December 31, 2012. Children with chronic complex condition and/or initial intensive care unit (ICU) management were excluded. Propensity score matching was used to detect differences in length of stay (LOS), readmissions, ICU transfer, and cost between groups.
RESULTS:40 257 hospitalizations met inclusion criteria; 1166 (2.9%) received only dexamethasone. In the matched cohort (N = 1284 representing 34 hospitals), the LOS was significantly shorter in the dexamethasone group compared with the prednisone/prednisolone group. The proportion of subjects with a LOS of 3 days or more was 6.7% in the dexamethasone group and 12% in the prednisone/prednisolone group (P = .002). Differences in all-cause readmission at 7- and 30 days were not statistically significant. The dexamethasone group had lower costs of index admission ($2621 vs $2838; P < .001) and total episode of care (including readmissions) ($2624 vs $2856; P < .001) compared with the prednisone/prednisolone group. There were no clinical significant differences in ICU transfer or readmissions between groups.
CONCLUSIONS:Dexamethasone may be considered an alternative to prednisone/prednisolone for children hospitalized with asthma exacerbation not requiring admission to intensive care.
 

J Pediatr. 2015 Sep;167(3):639-644.e1. doi: 10.1016/j.jpeds.2015.06.038.