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ABSTRACT 104: MAKING DECISIONS ABOUT MEDICATIONS IN CRITICALLY ILL CHILDREN A SURVEY OF CANADIAN PEDIATRIC CRITICAL CARE CLINICIANS

Duffett, M.1; Vanniyasingam, T.2; Choong, K.1; Thabane, L.2; Cook, D.3

Pediatric Critical Care Medicine: May 2014 - Volume 15 - Issue 4_suppl - p 29
doi: 10.1097/01.pcc.0000448833.82181.1c
Abstracts of the 7th World Congress on Pediatric Critical Care

1Pediatrics and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada 2Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada 3Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada

Background and aims: Clinicians caring for critically ill children often make decisions about medications when there is limited pediatric-specific evidence.

Aims: To understand the relative importance of factors that influence these decisions about drug therapy in pediatric critical care.

Methods: In this postal survey of physicians and pharmacists practicing in Canadian pediatric critical care units, respondents used 7-point scales to rate the importance of factors that may influence their decisions in 5 scenarios: corticosteroids for shock, intensive insulin therapy, stress ulcer prophylaxis, surfactant for acute respiratory distress syndrome, and sedation interruption. We used generalized estimating equations to examine the association between the importance of specific factors influencing decision-making and the scenario and the views and demographics of respondents.

Results: We included 117 participants (61% response rate). The 3 factors with the highest mean [Standard Deviation] overall ratings were severity of illness (5.8 [1.8]), physiologic rationale (5.2 [1.3]), and adverse effects (5.1 [1.9]). The lowest were drug costs (2.0 [1.5]), unit policies (2.9 [1.9]) and non-critical care RCTs (3.1 [1.9]). The relative importance of 8 of the 10 factors varied significantly among the 5 scenarios. Clinician characteristics associated with differences in the importance of factors were: frequent use of the intervention (7 factors), profession (5 factors), respondents’ assessment of the evidence (5 factors), and clinical (2 factors) and research (1 factor) experience.

Conclusions: The relative importance of many of the factors that clinicians consider when making decisions about medications varies by demographics, and depends on the clinical problem. This variation should be considered in knowledge translation research in this setting.

©2014The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies