Drug Use in Pediatric Patients Admitted to Rehabilitation For Severe Acquired Brain Injury: Analysis of the Associations With Rehabilitation Outcomes

• Published in: Paediatric drugs 2021, Vol.23 (1), p.75-86
• Main Authors: Pozzi, Marco, Galbiati, Sara, Locatelli, Federica, Carnovale, Carla, Radice, Sonia, Strazzer, Sandra, Clementi, Emilio
• Format: Article
• Language: English
• Subjects: Age; Brain; Brain damage; Cardiovascular agents; Coma; Complications and side effects; Consciousness; Corticosteroids; Drug therapy; Drug use; Encephalitis; Etiology; Injuries; Intensive care; Internal Medicine; Intracranial pressure; Medicine; Medicine & Public Health; Melatonin; Mortality; Original Research Article; Patients; Pediatrics; Pharmacotherapy; Physiological aspects; Prognosis; Rehabilitation; Sick children; Traumatic brain injury; Variables
• ISSN: 1174-5878; 1179-2019
• DOI: 10.1007/s40272-020-00429-9

Introduction Patients with severe acquired brain injuries require drug therapies in intensive care for life support and injury treatment. Patients who then access rehabilitation usually maintain their drug treatments long term, with a potential influence on the rehabilitation course. Whereas drug effects have been reported for specific drugs and clinical issues in adults, comprehensive data on pediatric patients with traumatic and non-traumatic injuries are scant. Objectives The aims of this study were to describe the therapeutic classes and groups of drugs prescribed to pediatric inpatients recovering from severe acquired brain injury when they enter rehabilitation; to assess whether clinical variables may determine the use of drug classes; and to assess whether the use of drug classes may be associated with differences in rehabilitation outcomes. Methods We carried out a retrospective chart review, following a previous study on the clinical-epidemiological characteristics of our patients. We collected information on drug therapies present at admittance to rehabilitation and analyzed their distribution according to therapeutic classes and groups. We verified the associations of drug groups with clinical variables (putatively antecedents to drug use) and with rehabilitation outcomes (putatively resultant of drug use and of clinical variables) in regression models. The clinical variables considered were injury etiology, Glasgow Outcome Score (GOS) at admittance to rehabilitation, sex, age at injury, plus two aggregate factors resulting from the previous work, ‘neurological dysfunction’ regarding the use of devices and ‘injury severity’ regarding the neurological status. The rehabilitation outcomes used were death after rehabilitation, persistence of a vegetative/minimally conscious state, coma duration, duration of the rehabilitation stay, rehabilitation efficiency (GOS at discharge minus GOS at admittance, divided by the length of rehabilitation stay). Results We described the distribution of drug classes and groups among pediatric patients with severe acquired brain injuries. Regarding the associations between drug classes and clinical variables, we found greater use of cardiovascular agents with higher patient age, ‘neurological dysfunction’ score, and with an etiology of hypoxic brain injury. The use of antithrombotic agents was greater with higher patient age and ‘neurological dysfunction’ score. Glucocorticoid use was greater with higher GOS at admitt