ST. LOUIS - It’s 3 a.m., and your 15-month-old daughter has just awakened crying with noisy breathing. She’s coughing frequently and sounds like a dog barking. When you call your pediatrician, you’re told to take her to the Pediatric Emergency Department for evaluation. After evaluation, the physician diagnoses her with croup and prescribes a corticosteroid to improve her symptoms by reducing the inflammation in her larynx (voice box).
Do you ever wonder how your physician decides which medicine to give? Does he give a single dose of dexamethasone, or choose prednisolone that is given for several days? Which medicine has been shown to be more effective? The answer lies in evidence –based medicine (EBM).
EBM is the process of systematically reviewing research findings and combining them with clinical expertise to provide the best, most appropriate care to patients. Simply put, EBM helps health care providers make medical decisions based on up-to-date research, clinical experience and what’s best for the patient.
EBM is not “cookbook” medicine where a physician simply follows a “recipe” to treat every patient in an identical way to achieve the same results. Instead, your physician uses the best available research along with her individual clinical expertise. Neither alone is enough to treat your child effectively. Without both clinical expertise and current research evidence, the patient’s care may not be what it should be.
Here’s a very good example using the croup diagnosis. A single, oral dose of dexamethasone has been demonstrated to be effective in reducing the symptoms of croup. Dexamethasone will last longer in the body than other steroids (36-54 hours), thereby requiring only a single dose during the emergency department visit. Multiple doses of dexamethasone have been studied but were no more effective than a single dose.
The other corticosteroid option is prednisolone. However, studies have shown that children who receive prednisolone have more return visits to the emergency department for continued symptoms than children who received dexamethasone. Thus, if your child receives prednisolone, your child will often need a three to five day course of the medication as opposed to the single dose of dexamethasone.
So, as you drive home from the emergency department at 4 a.m. following the single oral dose of dexamethasone, you’re thankful for the peace of mind that your child is improving, that you won’t have to find a 24-hour pharmacy to fill a prescription and that your emergency physician uses evidence-based medicine.
Dr. Cole Condra is a Mercy Clinic pediatric emergency medicine physician with Mercy Children’s Hospital. For more information, please visit www.mercychildrens.net.