Pediatric emergency department outcomes comparing levalbuterol vs

PEDIATRIC EMERGENCY DEPARTMENT OUTCOMES COMPARING
LEVALBUTEROL VS. RACEMIC ALBUTEROL
Timothy R. Myers BS, RRT, Marsha Rogers CRT, John C. Carl MD, Carolyn Kercsmar MD. Rainbow Babies & Children’s Hospital. Cleveland, Ohio. Background: Pediatric asthma is a chronic condition of childhood with increasing prevalence. Emergency
Department (ED) treatment of asthma constitutes a failure in outpatient management. Frequently, ED
asthma treatment is unsuccessful and patients are admitted. Our ED data the past 5 years yielded an average
admission rate of approximately 41%. The purpose of this study was to determine if levalbuterol resulted in
improved clinical outcomes compared to racemic albuterol. Specifically, we sought to observe a decrease
in admission rate. Methods: An a priori analysis powered at 80% (p-value <0.05) indicated a need to
randomize 532 children to detect a 10% decrease in admission rate. Patients who consented for
participation were randomized in a double-blind fashion to receive either 2.5 mg albuterol or 1.25 mg
levalbuterol delivered by a high-density Nebutech (Salter Labs, Irvine, Ca.) nebulizer. We utilized our
assessment-driven ED Asthma Carepath (ED-ACP) to control for treatment standardization between
groups. Our ED-ACP standardizes assessments & therapy (oxygen, albuterol aerosols, corticosteriods) at
prescribed intervals. Assessments and /or treatments were delivered every 20 minutes. Intensification of
therapy was provided with either subcutaneous epinephrine (SQ Epi) injection (initially) and/or
Ipratropium (during therapy). Treatment was discontinued when discharge criteria were met: good air
exchange, mild / absent end expiratory wheezing, no accessory muscle usage, SpO2 > 93%, and respiratory
rate<40/min. Patients were observed for one hour after their last treatment then discharged. Patients not
meeting discharge criteria after 6 aerosols or 1 hour of continuous aerosols were admitted or transferred. A
chronic asthma severity was assigned based on history, symptoms, and therapeutic drug usage. Fisher Exact
Tests were used to compare race, gender, and administration of SC Epi & Ipratropium. A Pearson chi -
square was used to compare chronic severity & admit vs. discharge status. Unpaired t-tests were used to
compare age, ED LOS, initial SpO2 & aerosols delivered. Significance was set at p < 0.05. Results: This
study randomized 552 children to treatment. Below are demographic and clinical outcome data reported as
raw, mean (SD) or percentages with p-values.

Demographics
Levalbuterol
Racemic Albuterol
Outcome Data


Conclusion: Levalbuterol resulted in a clinical and statistical decrease in admission rate and treatments
provided in our ED. An 8% decrease in hospital admission rate could result in a net savings of
approximately $200,000 per year at our institution.

Source: http://www.salterlabs.com/store/downloads/112.pdf