Medication Dosing for Children During Out-of-hospital Emergencies Deviates From National Guidelines in Many Cases

A study of children treated in out-of-hospital emergencies by emergency medical services found large variances in medication dosing, with many deviating from national guidelines that are based on weight. The study, “Deviation From National Dosing Recommendations for Children Having Out- of-Hospital Emergencies,” reported that only 42.6 out of 100 administrations for 10 commonly used medications were consistent with national guidelines. The study, published in the August 2023 issue of Pediatrics (published online July 10) examined a dataset of electronic health records from approximately 2,000 U.S.-based emergency medical services and 990,497 pediatric encounters. Researchers reviewed records of patients who received these medications: lorazepam, diazepam, midazolam, fentanyl, hydromorphone, morphine, ketorolac, epinephrine, diphenhydramine, and methylprednisolone. Most deviations represented an underdose, especially sedating medications, including benzodiazepines and morphine. The study also noted the deviations occurred across different agency types and statuses. The authors observe that the correct dosing of medications in the prehospital setting is essential to emergency pediatric care and has implications for both improving outcomes and avoiding adverse events. They suggest the findings may have multiple causes, including differences in protocols and errors in dosing, and suggest future educational, quality improvement, and research activities to improve adherence to national dosing guidelines.

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.