ABSTRACT
Systemic corticosteroids constitute standard treatment in children with acute obstructive laryngitis (croup). However, there is some uncertainty in relation with the magnitude of the benefits and risks associated with their use. To answer this question, we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We identified six systematic reviews including 25 randomized trials relevant for the question of interest. We extracted data from the systematic reviews, reananalysed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. We concluded the use of systemic corticosteroids increases the number of patients with clinical improvement at 12 hours and reduces the risk of readmission.
Los corticoides sistémicos constituyen un tratamiento habitual en los niños con laringitis aguda obstructiva (croup), sin embargo, no se conoce exactamente cuál es la magnitud de los beneficios y riesgos asociados a su uso. Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud a nivel mundial, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Identificamos seis revisiones sistemáticas que en conjunto incluyen 25 estudios aleatorizados pertinentes. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos tablas de resumen de los resultados utilizando el método GRADE. Concluimos que el uso de corticoides sistémicos aumenta la cantidad de pacientes con mejoría clínica a las 12 horas y disminuye el riesgo de readmisión.
Subject(s)
Croup/drug therapy , Glucocorticoids/therapeutic use , Hospitalization/statistics & numerical data , Child , Databases, Factual , Humans , Patient Readmission/statistics & numerical data , Randomized Controlled Trials as Topic , Time Factors , Treatment OutcomeABSTRACT
Bronchiolitis is a prevalent disease in children under two years of age, which carries significant morbidity and mortality. However, there is controversy regarding the optimal therapeutic management. Leukotriene inhibitors have been proposed as an alternative, although its efficacy is not clear yet. Searching in Epistemonikos database, which is maintained by screening multiple databases, we identified two systematic reviews comprising six trials addressing the question of this article. We extracted data, combined the evidence using meta-analysis and generated a summary of findings following the GRADE approach. We concluded leukotriene inhibitors might not decrease mortality levels on bronchiolitis patients and it is not clear whether they decrease length of hospital stay. They might reduce recurrent wheezing, but the certainty of the evidence is low, and they increase adverse effects.
Subject(s)
Bronchiolitis/drug therapy , Hospitalization/statistics & numerical data , Leukotriene Antagonists/therapeutic use , Bronchiolitis/mortality , Bronchiolitis/physiopathology , Humans , Infant , Length of Stay , Leukotriene Antagonists/adverse effectsABSTRACT
BACKGROUND: Asthma is one of the chronic diseases that generate an impact on quality of life and major health care expenses. AIM: To evaluate the impact of asthma on primary attention expenses, the health related quality of life (HRQOL) and the sanitary resources use. MATERIAL AND METHODS: Follow up of a cohort of 56 asthmatic children aged 6 to 14 years (56% women), during 12 months. The severity and the impact of the disease on HRQOL was assessed using the International Study of Asthma and Allergies in Childhood (ISAAC) video questionnaire and the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) respectively Costs were derived from the number of medical attentions, hospital admissions, medication requirements, school absenteeism among patients and work absenteeism among caregivers. RESULTS: Patients required twice the number of medical attentions than the general population. Fourteen percent of children had severe asthma. Compared with subjects without severe asthma, the latter required more attentions (3.8 and 9.7 attentions per year respectively, p< 0.01), had a lower PAQLQ score (4.1 +/-0.11 and 5.2 +/- 1 respectively, p< 0.05) and a higher school absenteeism (10 and 27 days per year respectively, p < 0.01). Medication use was not different between patients with and without severe asthma. They early cost per patient was $ 106,550 (Chilean pesos). CONCLUSIONS: Asthma has a great impact on HRQOL and the use of primary attention resources, specially those children with severe asthma.
Subject(s)
Asthma , Health Care Costs/statistics & numerical data , Health Expenditures/statistics & numerical data , Primary Health Care/economics , Quality of Life/psychology , Adolescent , Asthma/economics , Asthma/psychology , Asthma/therapy , Child , Chronic Disease , Epidemiologic Methods , Female , Humans , Male , Socioeconomic Factors , Urban PopulationABSTRACT
Background: Asthma is one of the chronic diseases that generate an impact on quality of life and major health care expenses. Aim: To evaluate the impact of asthma on primary attention expenses, the health related quality of life (HRQOL) and the sanitary resources use. Material and Methods: Follow up of a cohort of 56 asthmatic children aged 6 to 14 years (56 percent women), during 12 months. The severity and the impact of the disease on HRQOL was assessed using the International Study of Asthma and Allergies in Childhood (ISAAC) video questionnaire and the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) respectively Costs were derived from the number of medical attentions, hospital admissions, medication requirements, school absenteeism among patients and work absenteeism among caregivers. Results: Patients required twice the number of medical attentions than the general population. Fourteen percent of children had severe asthma. Compared with subjects without severe asthma, the latter required more attentions (3.8 and 9.7 attentions per year respectively, p< 0.01), had a lower PAQLQ score (4.1 ±0.11 and 5.2 ± 1 respectively, p< 0.05) and a higher school absenteeism (10 and 27 days per year respectively, p < 0.01). Medication use was not different between patients with and without severe asthma. They early cost per patient was $ 106,550 (Chilean pesos). Conclusions: Asthma has a great impact on HRQOL and the use of primary attention resources, specially those children with severe asthma.
