Presenter: Brian K. Alverson, MD
This PHM 2023 session focused on using evidence (including small studies and case reports) to guide the use of novel therapies in the care of children hospitalized with common inpatient illnesses. Dr. Alverson used humor and patient cases to debunk the need for large studies to impact the care we provide patients.
Dr. Alverson contended that a large study or many studies are not needed to make a change in practice, nor should clinicians shy away from variation in practice when unclear evidence exists and there is no good reason not to try something. He provided several examples including:
- Use of steroids in septic arthritis to improve the length of stay and potentially also long-term outcomes, with relatively low cost and few negative outcomes.
- Considering rectal acetaminophen for non-opioid pain control, thus decreasing length of stay in herpes simplex virus stomatitis.
- Honey orally to improve oral intake in herpes simplex virus stomatitis (over narcotic use) as well as for treatment of cough (as opposed to dextromethorphan) in patients over the age of one.
- Administering half-strength apple juice for gastroenteritis to improve the likelihood of enteral hydration and decrease the need for intravenous rehydration.
- Use of probiotics for functional abdominal pain, highlighting that is more efficacious than placebo and may result in improvement of pain in 50% of patients.
- The use of aprepitant for cannabis hyperemesis. Although expensive, it can have a dramatic impact on the cessation of vomiting and decrease the length of stay.
- Large studies and trials are not needed for effective treatments to be found that can be impactful in the care of patients.
- Clinicians should consider trying novel therapies where no clear evidence or guidelines exist.
Dr. Kendhari (@dr_leenz) is an associate professor of clinical pediatrics at the University of Illinois College of Medicine in Peoria, Ill., and a pediatric hospitalist, sedation physician, and pediatric hospital medicine fellowship program director at the Children’s Hospital of Illinois in Peoria, Ill. She is also the co-chair of the American Academy of Pediatrics section on hospital medicine’s women in PHM subcommittee.