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OBJECTIVE: It is perceived by many pharmacists that inadequate training and the resulting lack of confidence hinder participation in medical emergencies. There is insufficient information detailing training programs for pharmacists responding to pediatric medical emergencies. The primary objective of this study was to compare competency scores pre and post participation in the pediatric medical emergency training (PedMET) program. The secondary objectives included comparing confidence and knowledge for participation in pediatric medical emergencies, knowledge of resources and error prevention tools, description of the median time to prepare medications, and the most common errors that occurred during simulation. METHODS: A comprehensive didactic lecture and simulation-based training were designed and contained pre- and post-competencies to assess pharmacists' knowledge related to pediatric medical emergencies. Self-assessments were included to determine pharmacists' confidence levels in knowledge and preparation of medications. Feedback was solicited from participants to identify areas of improvement for the program. Standards for QUality Improvement Reporting Excellence (SQUIRE) 2.0 was used to report findings. RESULTS: Twenty-nine pharmacists of diverse training (e.g., residency vs nonresidency) and experience levels completed the program between July 2021 and March 2023. Competency scores improved from a median of 86% to 97% (p value < 0.001). Significant improvement was detected in pharmacists' confidence in their ability to prepare complex medications during medical emergencies (p value = 0.001). CONCLUSIONS: Following the implementation of didactic and simulation-based training, pharmacists' knowledge and confidence increased. Departments of pharmacy should consider implementing pharmacist--specific training programs for all pharmacists who respond to pediatric medical emergencies.
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OBJECTIVE: We aimed to characterize intravenous (IV) methylprednisolone (MP) dosing regimens and clinical outcomes for children hospitalized for critical asthma (CA). METHODS: A single-center, retrospective review was performed of children admitted to the pediatric intensive care unit (PICU) for CA between September 2015 and October 2019. Patients 5-to 17-year-olds, initiated on continuous nebulized albuterol, and prescribed at least one dose of IV MP were included. The primary outcome was to characterize PICU MP dosing. Cohorts were then compared by MP dosing: conservative-dose methylprednisolone (CDMP, ≤ 0.5 mg/kg/dose every 6 h) and standard-dose methylprednisolone (SDMP, > 0.5 mg/kg/dose every 6 h). Clinical efficacy endpoints were the duration of continuous nebulized albuterol and PICU length of stay (LOS). Safety endpoints included corticosteroid-related adverse events. RESULTS: Of 168 children studied, 50 (29.8%) were prescribed CDMP and 118 (70.2%) SDMP. The overall mean MP dose was 31.3 ± 19.6 mg (weight-adjusted: 0.77 ± 0.32 mg/kg/dose). Compared to those prescribed SDMP, those prescribed CDMP had a shorter median duration of continuous nebulized albuterol (12.8 [IQR: 10.5-20] versus 17.3 [IQR: 11.3-29.7] hours, p = 0.019) and median PICU LOS (0.9 [IQR: 0.7-1.4] versus 1.2 [IQR: 0.9-1.8] days, p = 0.012). No corticosteroid-related adverse events were observed. In adjusted models, weight-adjusted IV MP dose was not associated with PICU LOS or duration of continuous nebulized albuterol. CONCLUSIONS: Intravenous MP dosing for pediatric CA varied widely in our study sample. Prospective, controlled trials are required to validate our observations including clinical efficacy and safety endpoints.
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Objective: Vitamin K (VK) is commonly prescribed for pediatric sepsis-induced coagulopathy without trial-derived evidence to support its use for this indication. The purpose of this study was to characterize national prescribing trends for VK in this population. Patients and Methods: This is a multicenter retrospective cohort study using the Pediatric Health Information System registry including children 0 to 17 years of age hospitalized for sepsis in the pediatric intensive care unit from January 2016 through December 2022. The primary outcome was overall, annual, and center-specific VK prescribing rates. Descriptive data included demographics, length of stay, and rates of VK deficiency, hepatic insufficiency, red blood cell (RBC) transfusion, venous thromboembolism (VTE), and mortality. VK prescribing trends were assessed using Joinpoint regression. Descriptive statistics employed included Wilcoxon rank-sum, student's t, and chi-square tests. Results: Of the 31â 221 encounters studied, 4539 (14.6%) were prescribed VK (median center-specific rate: 14.2%; interquartile range [IQR]: 8.8-21%) with a linear annual trend decreasing from 17.3% in 2016 to 13.3% in 2022 (-0.6%/year, r2 = .661). Those prescribed VK had greater rates of hepatic dysfunction (20.5% vs 3.1%), RBC transfusion (26.5% vs 11.2%), VTE (12.5% vs 4.6%), mortality (17.1% vs 4.4%), and median length of stay (16 [IQR: 8-33] vs 8 [4-15] days) (all P < .001). VK deficiency was diagnosed in 0.2% of encounters. Conclusions: In this multicenter retrospective cohort, VK prescribing was common among critically ill children diagnosed with sepsis. Phased trials are needed to demonstrate clinical efficacy and safety for VK in this population.
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Drug-induced liver injury (DILI) is a rare adverse drug reaction (ADR) in pediatric patients and limited reports exist examining ampicillin-sulbactam-induced liver injury. This report summarizes a 12-year-old male who received ampicillin-sulbactam and subsequently developed liver injury characterized by elevated serum aminotransferases and bilirubin. Ampicillin-sulbactam was subsequently discontinued and the patient's liver function tests (LFTs) rapidly improved. This report describes the rare adverse reaction of ampicillin-sulbactam-induced liver injury.