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

Project AimTo retrospectively evaluate a clinical management algorithm for acute wheezers in a UK Pediatric Emergency Department (PED). Overview and RationaleAcute 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. EvaluationIn 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. ResultsOver a 48-month period, we reduced OCS intolerability by 67.2% and OCS drug costs by 85.8% (saving 41,470.14) pound, while not significantly influencing the other outcomes. ConclusionsReduced 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).

Automated summary

The aim of this study was to retrospectively evaluate a clinical management algorithm for acute wheezers in a UK Pediatric Emergency Department. By modifying the steroid treatment and implementing various measures, the algorithm successfully reduced steroid intolerability and costs without significantly affecting other outcomes.