Abstract
BackgroundDrooling is common in children with neurological disorders, but its management is very challenging, Scopolamine transdermal patch (STP) appears to be useful in controlling drooling, although it is not approved for this indication and there are limited clinical studies about its effectiveness. This study aimed (1) to assess the impact of STP use on the severity of drooling and on the frequency of emergency department (ED) and hospital readmission (RA) visits related to drooling, and (2) to determine the level of family satisfaction with STP when used in children with neurological disorders.MethodsThis is a retrospective cohort study of all pediatric patients aged 3–14 years, with non-progressive neurodevelopmental disability, who used STP for more than one year during the period between April 2015 and July 2018 (n = 44). Data on demographics, clinical status, comorbidities, STP dose and duration, other medications, ED and RA visits were collected. Follow-up phone-call interviews with parents/caregivers were performed using a parent-reported frequency and severity rating scale of sialorrhea. Absolute and relative risk reductions were calculated to assess the impact of STP on ED and RA visits. Significance was considered at p-value of ≤ 0.05.ResultsSTP use showed significant reduction in severity of drooling (p < 0.001), wiping of the child’s mouth (p < 0.001), bibs or clothing changes (p < 0.001), choking and aspiration of saliva (p = 0.001). The Relative Risk Reduction of the drooling-related ED and RA visits were 86% and 67% respectively. Nearly two-thirds (60%) of caregivers were satisfied with using STP.ConclusionsThis is the first study of its kind done in Saudi Arabia demonstrating favorable impact of STP use by children on the consequences associated with drooling and with the frequency of ER and RA visits due to drooling. Development of a medication use protocol is recommended to standardize STP treatment in order to optimize its effectiveness. This study serves as baseline information for future prospective interventional studies.
Highlights
Drooling is common in children with neurological disorders, but its management is very challenging, Scopolamine transdermal patch (STP) appears to be useful in controlling drooling, it is not approved for this indication and there are limited clinical studies about its effectiveness
Of the records of 69 children, those with progressive neurodevelopmental disability, those whose parents could not be reached for interview, and those who were on STP for less than one year at the time of study were all excluded
Our study showed favorable impacts of STP use by children on the consequences associated with drooling, with a significant reduction in the proportion of children with severe/very severe drooling, need for wiping of the child’s mouth, need for clothing changes and choking
Summary
Drooling is common in children with neurological disorders, but its management is very challenging, Scopolamine transdermal patch (STP) appears to be useful in controlling drooling, it is not approved for this indication and there are limited clinical studies about its effectiveness. This study aimed (1) to assess the impact of STP use on the severity of drooling and on the frequency of emergency department (ED) and hospital readmission (RA) visits related to drooling, and (2) to determine the level of family satisfaction with STP when used in children with neurological disorders. It could be due to failure to retain saliva inside the mouth, or difficulty with swallowing [3] It was prevalent in 40% of a population-based study of 7 to 14-year-old children with cerebral palsy (CP) [4], and in 58% of children with CP attending special schools in the UK [5], while the pooled prevalence estimate determined in a recent metaanalysis was 44% [6]. Sialorrhea has a negative impact on functional and clinical outcomes for patients, families, and caregivers
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