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Variation Seen in Dosing of Meds at Prehospital Pediatric Encounters

Lowest consistency with guidelines was seen for diazepam and lorazepam; most deviations represented an underdose

By Elana Gotkine HealthDay Reporter

MONDAY, July 10, 2023 (HealthDay News) — For pediatric patients in the prehospital setting, weight-based dosing often varies from national guidelines, according to a study published online July 10 in Pediatrics.

Sriram Ramgopal, M.D., from the Northwestern University Feinberg School of Medicine in Chicago, and Christian Martin-Gill, M.D., M.P.H., from the University of Pittsburgh School of Medicine, examined prehospital patient care records for children (<18 years) from approximately 2,000 emergency medical services agencies from 2020 to 2021. Dosing deviations (defined as ≥20 percent of the weight-appropriate dose from national guidelines) were assessed for lorazepam, diazepam, and midazolam; fentanyl, hydromorphone, morphine, and ketorolac; intramuscular epinephrine and diphenhydramine; intravenous epinephrine; and methylprednisolone.

Overall, 6.4 percent of 990,497 pediatric encounters received at least one nonnebulized medication. A total of 53.9 percent of the nonnebulized doses were for the studied drugs. The researchers found that the overall consistency with national guidelines was 42.6 per 100 administrations among the encounters that received a study drug and had a documented weight. Appropriate dosing was most common with methylprednisolone, intramuscular epinephrine, and ketorolac (75.1, 67.9, and 56.4 percent, respectively), while the lowest consistency with national guidelines was seen for diazepam and lorazepam (19.5 and 21.2 percent, respectively). Most deviations represented an underdose; the greatest underdoses were seen for lorazepam and morphine (74.7 and 73.8 percent, respectively).

“As these findings may have multiple causes, including differences in protocols and errors in dosing, addressing these deviations should be a target for future educational, quality improvement, and research activities,” the authors write.

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