We performed a retrospective cohort study examining children with HSCR at US children\'s hospitals from 2008 to 2018 using the Pediatric Health Information System database with an associated primary pull-through operation performed before 60 d of age. The intervention assessed was the administration of BT concerning the timing of primary pull-through, and two groups were identified: PRO (received BT at or after primary pull-through, before HAEC) and NOT (never received BT, or received BT after HAEC). The primary outcome was time from pull-through to the first HAEC admission. The Cox proportional hazards model was developed to examine the BT administration effect on the primary outcome after controlling for patient-level covariates.
We examined a total of 1439 children (67 in the PRO and 1372 in the NOT groups). A total of 308 (21.4%) developed at least one episode of HAEC, including 76 (5.3%) who had two or more episodes. Between 2008 and 2018, the frequency of BT administration has increased from three to 20 hospitals with a frequency of administration between 2.2% and 16.2%. Prophylactic BT (PRO) was not associated with increased time to HAEC event on adjusted analysis.
Among children with HSCR undergoing primary pull-through surgery, prophylactic BT administration did not demonstrate increased time to first HAEC event. A better-powered study with prophylactic BT is required to determine the effect on HAEC occurrence and timing.
Level II (retrospective cohort study).
我们进行了一项回顾性队列研究,从2008年至2018年,在美国儿童医院使用儿科健康信息系统数据库,对患有HSCR的儿童进行了回顾性队列研究,并在60d之前进行了相关的初级牵拉手术。评估的干预措施是关于主要通过时机的BT管理,并确定了两组:PRO(在主要拉拔时或之后接受BT,在HAEC之前)和NOT(从未收到BT,或在HAEC后接受BT)。主要结果是从拉动到第一次HAEC入院的时间。建立了Cox比例风险模型,以检查在控制患者水平的协变量后,BT给药对主要结局的影响。
我们共检查了1439名儿童(PRO组67名,NOT组1372名)。共有308例(21.4%)发生了至少一次HAEC发作,包括76例(5.3%)有两次或更多次发作。在2008年至2018年期间,BT管理的频率从3家增加到20家医院,管理频率在2.2%至16.2%之间。经校正分析,预防性BT(PRO)与HAEC事件发生时间的增加无关。
在接受原发性牵拉手术的HSCR儿童中,预防性BT给药未显示至首次HAEC事件的时间增加.需要更好的预防性BT研究来确定对HAEC发生和时机的影响。
II级(回顾性队列研究)。