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Adair E, Dibaba D, Fowke JH, et al. The Impact of Terbutaline as Adjuvant Therapy in the Treatment of Severe Asthma in the Pediatric Emergency Department. Pediatr Emerg Care. 2020;doi: 10.1097/PEC.0000000000002269.
Adair, E., Dibaba, D., Fowke, J. H., & Snider, M. (2020). The Impact of Terbutaline as Adjuvant Therapy in the Treatment of Severe Asthma in the Pediatric Emergency Department. Pediatric emergency care, . https://doi.org/10.1097/PEC.0000000000002269
Adair, Erik, et al. "The Impact of Terbutaline as Adjuvant Therapy in the Treatment of Severe Asthma in the Pediatric Emergency Department." Pediatric emergency care vol. (2020). doi: https://doi.org/10.1097/PEC.0000000000002269
Adair E, Dibaba D, Fowke JH, Snider M. The Impact of Terbutaline as Adjuvant Therapy in the Treatment of Severe Asthma in the Pediatric Emergency Department. Pediatr Emerg Care. 2020 Oct 29; doi: 10.1097/PEC.0000000000002269. Epub 2020 Oct 29. PMID: 33136831.
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Pediatr Emerg Care. 2020 Oct 29; doi: 10.1097/PEC.0000000000002269. Epub 2020 Oct 29.

The Impact of Terbutaline as Adjuvant Therapy in the Treatment of Severe Asthma in the Pediatric Emergency Department.

Pediatric emergency care

Erik Adair, Daniel Dibaba, Jay H Fowke, Mark Snider

Affiliations

  1. From the Division of Pediatric Emergency Medicine, Le Bonheur Children's Hospital.
  2. The University of Tennessee Health Science Center.
  3. Tennessee Clinical and Translational Science Institute.
  4. Division of Epidemiology, Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN.

PMID: 33136831 DOI: 10.1097/PEC.0000000000002269

Abstract

Parenteral β-agonists are often used as adjuvant treatment for severe asthma exacerbations in pediatric patients. We wanted to determine if the addition of a single dose of parenteral terbutaline to our asthma protocol resulted in fewer pediatric intensive care unit (PICU) admissions.

METHODS: Patients were identified using a retrospective cohort analysis from a single, tertiary care, urban children's hospital. Patients presenting directly to our emergency department aged 2 to 18 years were included if they had a diagnosis of severe asthma exacerbation, defined by an initial Respiratory Clinical Score (RCS) of 9 or higher. A total of 787 patients were identified during the study timeframe (December 16, 2017, to December 31, 2018), and of those, 651 patients met study criteria and were included in the analysis. The χ test was used to establish P values for categorical variables. For normally distributed variables, a t test was used. For nonnormally distributed variables, the Kruskal-Wallis test was used. A P value of 0.05 or less was interpreted as statistically significant.

RESULTS: Patients who received terbutaline had an increased risk of admission to the PICU (P < 0.001). This association was lost after controlling for age, sex, continuous albuterol use, and intramuscular epinephrine use (P = 0.362). Patients receiving terbutaline in the emergency department also had a higher risk of admission to the hospital (odds ratio, 1.55; confidence interval, 1.08-2.22; P = 0.020) as compared with their nonterbutaline counterparts. Overall, patients in the terbutaline group had a higher initial RCS at presentation. Upon further analysis, patients with the same RCS at presentation were more likely to be admitted if they received terbutaline than those who did not. There was no statistically significant difference in length of stay (P = 0.298) and BiPAP/CPAP use (P = 0.107). The patients on terbutaline were relatively more likely to require oxygen (P = 0.003) and intramuscular epinephrine (P = 0.010) than the patients not on terbutaline.

CONCLUSIONS: Terbutaline administration given to pediatric patients experiencing a severe asthma exacerbation was not associated with decreased PICU or general hospital floor admission. The study is limited given that it was a retrospective analysis. Further randomized controlled trials are needed to assess the role of terbutaline in severe acute asthma exacerbations in pediatric patients.

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