Serum theophylline testing in a pediatric emergency setting: potential benefit of rapid assays.
This study assessed the potential clinical benefit of rapid theophylline assays in an urban pediatric emergency department by 1) examining current practices of monitoring and adjusting theophylline therapy in children with asthma and 2) determining the relationship between these practices and the adequacy of theophylline therapy and duration of emergency department visits. Of 213 consecutive wheezing children who reported taking theophylline, levels were not obtained on 114 (52%), even though theophylline dosages were adjusted for 43 (38%). Of the 99 patients who had theophylline levels drawn, 80 were successfully enrolled in the study. Most children who received intravenous theophylline therapy 1) were treated prior to availability of serum theophylline results (83%), which took an average of one hour and 48 minutes, and 2) received suboptimal doses (12% were excessive, and 57% were inadequate). The latter patients were more likely to require additional intravenous theophylline that prolonged their stay in the emergency department. If intravenous theophylline therapy was not administered, the wait for the theophylline level was longer than the visit itself. These findings indicate that rapid immunoassays for theophylline have the potential to improve management of children with acute asthma in an emergency department by improving the accuracy of dosing and decreasing the duration of stay.
Shaw
K N
KN
Department of Pediatrics, Children's Hospital of Philadelphia, PA 19104.
Fleisher
G R
GR
Schwartz
J S
JS
D001249:Asthma / Q000097:blood / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D004636:Emergency Service, Hospital; D006776:Hospitals, Pediatric; D006801:Humans; D007118:Immunoassay; D013806:Theophylline / Q000008:administration & dosage / Q000097:blood* / Q000627:therapeutic use
D013806:Theophylline