Analysis of the application of glucocorticoids in eight pediatric neurological disorders in China

Abstract

Objective: To investigate the application of glucocorticoids in children with neurological diseases by pediatricians, and to provide baseline data for further standardization of glucocorticoids application. Methods: This was a cross-sectional survey, an electronic questionnaire survey was conducted online from July 8, 2019 to July 28, 2019 through the Subspecialty Group of Clinical Pharmacology, the Subspecialty Group of Neurology, and Expert Committee on Rational Use of Medicines for Children in the Society of Pediatrics, Chinese Medical Association. This survey was conducted for the application of glucocorticoids in 8 neurological diseases in children, and compared with the current guidelines or consensus to judge whether the application was standard. A total of 1 850 pediatricians from 1 073 hospitals were surveyed. Surveyed diseases included bacterial meningitis, anti-N-methyl-D-aspartate receptor encephalitis, neuromyelitis optica spectrum disease (NMOSD), multiple sclerosis, Guillain-Barre syndrome, myasthenia gravis, juvenile dermatomyositis, and Duchenne muscular dystrophy. In order to explore the associated factors of standardized glucocorticoid application, the level of hospital, whether there was an independent department of pediatric neurology, and working experience of the doctor were used as independent variables. The χ2 test and multivariate Logistic analysis was used for statistical analysis. Results: A total of 1 834 (99.1%) valid questionnaires were collected from 1 073 hospitals in 31 provinces, autonomous regions and municipalities. The coincidence rate with recommendation of the current guideline or consensus on glucocorticoids was 5.8% (51/879) in juvenile dermatomyositis, 13.7% (153/1 115) in myasthenia gravis, 18.2% (142/781) in bacterial meningitis, 18.5% (310/1 680) in anti-N-methyl-D-aspartate receptor encephalitis, 23.0% (248/1 079) in Duchenne muscular dystrophy, 33.4% (322/964) in NMOSD and multiple sclerosis, and 43.5% (477/1 096) in Guillain-Barre syndrome. The most common one was the irregular course of treatment, and the coincidence rate was 36.8% (12.5%-62.2%). The multivariate Logistic regression analysis indicated that the use of glucocorticoids was more standardized in bacterial meningitis (OR=1.83, 95%CI 1.39-2.43, P<0.01), Guillain-Barre syndrome (OR=1.97, 95%CI 1.50-2.59, P<0.01), Duchenne muscular dystrophy (OR=1.85, 95%CI 1.38-2.48, P<0.01), juvenile dermatomyositis (OR=2.08, 95%CI 1.03-4.19, P=0.040) and N-methyl-D-aspartate receptor encephalitis (OR=0.302, 95%CI 0.20-0.46, P<0.01) and by pediatricians with pediatric neurology specialty in the hospital. Conclusions: The coincidence rate with recommendation of the current guideline or consensus on glucocorticoids is less than half in children with neurological diseases, and the use of glucocorticoids is more standardized in a variety of diseases by pediatricians with pediatric neurology specialty in the hospital, which indicates that the study of guidelines or consensus and the special training of pediatric neurologists should be further strengthened.