title: Gastric Acid Suppressant Prophylaxis in Pediatric Intensive Care: Current Practice as Reflected in a Large Administrative Database.
abstract: OBJECTIVE
  Stress-related gastrointestinal bleeding may occur in PICU patients. Raising gastric pH with acid suppressant medications is the accepted treatment. We describe the use of histamine 2 receptor blockers and proton pump inhibitors and associated factors among a national sample of PICU patients.
  
  
  METHODS
  Retrospective cohort analysis using Pediatric Health Information System clinically detailed administrative database.
  
  
  METHODS
  Forty-two children's hospitals throughout the United States.
  
  
  METHODS
  All hospitalizations for all patients 20 years old or younger, admitted directly to a PICU, from January 1, 2007, through December 31, 2011.
  
  
  METHODS
  None.
  
  
  RESULTS
  The exposure of interest was treatment with a histamine 2 receptor blocker, proton pump inhibitor, or both on the first day of PICU admission. Demographics, principal and additional diagnoses, and procedure codes were assessed. For each hospitalization, principal diagnosis, coagulation disorder, head trauma, spinal trauma, severe burns, sepsis, gastrointestinal hemorrhage, mechanical ventilation, blood product transfusion, and 10 complex chronic conditions were identified. The frequency of principal diagnoses was determined to identify the most prevalent PICU diseases. Acid suppressant use was categorized as high or low. Three hundred and thirty-six thousand ten inpatient hospitalizations were sampled. Histamine 2 receptor blocker or proton pump inhibitor was used in 60.0%, with histamine 2 receptor blocker alone in 70.4%, proton pump inhibitor alone in 17.8%, and both agents in 11.8%. Use increased over the sample years 2007 through 2011. Gastrointestinal bleeding occurred in 1.32% of hospitalizations with transfusion needed in 0.1%. Among most prevalent diagnoses, histamine 2 receptor blocker and proton pump inhibitor use ranged from 33% to 87%. Sepsis, coagulopathy, and mechanical ventilation identified higher use. Use of histamine 2 receptor blocker or proton pump inhibitor among hospitals varied considerably ranging from 28% to 87%.
  
  
  CONCLUSIONS
  Histamine 2 receptor blocker and proton pump inhibitor are prescribed in most PICU patients, but significant variation exists across health conditions and hospitals. Institutional preferences likely influence variation. Gastrointestinal hemorrhage is infrequent in the current era. Study data limitations prevent examination of associations between medication use and patient outcomes.
authors.affiliation: 1Department of Anesthesiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA. 2Division of Cardiac Critical Care, The Children's Hospital of Philadelphia, Philadelphia, PA. 3Center for Pediatric Clinical Effectiveness and Policy Lab, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. 4Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 5Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. 6Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 7Division of General Pediatrics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Costarino
authors.forename: Dingwei
authors.initials: D
authors.lastname: Dai
authors.forename: Rui
authors.initials: R
authors.lastname: Feng
authors.forename: Chris
authors.initials: C
authors.lastname: Feudtner
authors.forename: James P
authors.initials: JP
authors.lastname: Guevara
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005744:Gastric Acid; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000517:prevention & control*; D006635:Histamine H2 Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States; D055815:Young Adult
chemical_list: D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors