Julianne E Burns1,2, Cary Thurm3, James W Antoon4, Carlos G Grijalva5, Matt Hall3, Adam L Hersh6, Gabrielle Z Hester7, Emilie Korn1, Mario A Reyes8, Samir S Shah9, Balagangadhar R Totapally10, Ronald J Teufel11. 1. Department of Pediatrics, Division of Hospital Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 2. Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, California. 3. Children's Hospital Association, Lenexa, Kansas. 4. Department of Pediatrics, Vanderbilt University School of Medicine and Division of Hospital Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee. 5. Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee. 6. Department of Pediatrics, Division of Infectious Diseases, University of Utah, Salt Lake City, Utah. 7. Department of Value and Clinical Excellence, Children's Minnesota, Minneapolis, Minnesota. 8. Department of Pediatrics, Division of Hospital Medicine, Nicklaus Children's Hospital, Miami, Florida. 9. Department of Pediatrics, University of Cincinnati College of Medicine and Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 10. Department of Pediatrics, Herbert Wertheim College of Medicine, Florida International University and Division of Critical Care Medicine, Nicklaus Children's Hospital, Miami, Florida. 11. Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.
Abstract
OBJECTIVES: Coronavirus disease 2019 (COVID-19) treatment guidelines rapidly evolved during the pandemic. The December 2020 Infectious Diseases Society of America (IDSA) guideline, endorsed by the Pediatric Infectious Diseases Society, recommended steroids for critical disease, and suggested steroids and remdesivir for severe disease. We evaluated how medications for children hospitalized with COVID-19 changed after guideline publication. METHODS: We performed a multicenter, retrospective cohort study of children aged 30 days to <18 years hospitalized with acute COVID-19 at 42 tertiary care US children's hospitals April 2020 to December 2021. We compared medication use before and after the December 2020 IDSA guideline (pre- and postguideline) stratified by COVID-19 disease severity (mild-moderate, severe, critical) with interrupted time series. RESULTS: Among 18 364 patients who met selection criteria, 80.3% were discharged in the postguideline period. Remdesivir and steroid use increased postguideline relative to the preguideline period, although the trend slowed. Postguideline, among patients with severe disease, 75.4% received steroids and 55.2% remdesivir, and in those with critical disease, 82.4% received steroids and 41.4% remdesivir. Compared with preguideline, enoxaparin use increased overall but decreased among patients with critical disease. Postguideline, tocilizumab use increased and hydroxychloroquine, azithromycin, anakinra, and antibiotic use decreased. Antibiotic use remained high in severe (51.7%) and critical disease (81%). CONCLUSIONS: Although utilization of COVID-19 medications changed after December 2020 IDSA guidelines, there was a decline in uptake and incomplete adherence for children with severe and critical disease. Efforts should enhance reliable delivery of guideline-directed therapies to children hospitalized with COVID-19 and assess their effectiveness.
OBJECTIVES: Coronavirus disease 2019 (COVID-19) treatment guidelines rapidly evolved during the pandemic. The December 2020 Infectious Diseases Society of America (IDSA) guideline, endorsed by the Pediatric Infectious Diseases Society, recommended steroids for critical disease, and suggested steroids and remdesivir for severe disease. We evaluated how medications for children hospitalized with COVID-19 changed after guideline publication. METHODS: We performed a multicenter, retrospective cohort study of children aged 30 days to <18 years hospitalized with acute COVID-19 at 42 tertiary care US children's hospitals April 2020 to December 2021. We compared medication use before and after the December 2020 IDSA guideline (pre- and postguideline) stratified by COVID-19 disease severity (mild-moderate, severe, critical) with interrupted time series. RESULTS: Among 18 364 patients who met selection criteria, 80.3% were discharged in the postguideline period. Remdesivir and steroid use increased postguideline relative to the preguideline period, although the trend slowed. Postguideline, among patients with severe disease, 75.4% received steroids and 55.2% remdesivir, and in those with critical disease, 82.4% received steroids and 41.4% remdesivir. Compared with preguideline, enoxaparin use increased overall but decreased among patients with critical disease. Postguideline, tocilizumab use increased and hydroxychloroquine, azithromycin, anakinra, and antibiotic use decreased. Antibiotic use remained high in severe (51.7%) and critical disease (81%). CONCLUSIONS: Although utilization of COVID-19 medications changed after December 2020 IDSA guidelines, there was a decline in uptake and incomplete adherence for children with severe and critical disease. Efforts should enhance reliable delivery of guideline-directed therapies to children hospitalized with COVID-19 and assess their effectiveness.
Authors: James W Antoon; Carlos G Grijalva; Cary Thurm; Troy Richardson; Alicen B Spaulding; Ronald J Teufel; Mario A Reyes; Samir S Shah; Julianne E Burns; Chén C Kenyon; Adam L Hersh; Derek J Williams Journal: J Hosp Med Date: 2021-10 Impact factor: 2.899
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