by Carla Kemp • Senior Editor
Low-dose propofol alleviates migraines in pediatric ED patients
◆ Sheridan DC, et al. Pediatr Emerg Care. 2012;
28:1293-1296.
A subanesthetic dose of propofol was safe and more
effective than standard therapy at stopping migraine
headache among pediatric emergency department
patients, according to a small case-control study.
The American Academy of Neurology published recommendations in 2004 for the pharmacologic treatment
of migraine headache in children and adolescents. Since
then, little progress has been made in outpatient abortive
therapy. Reports in adults have shown that low-dose
propofol is an effective treatment for refractory headaches.
Based on the success of off-label use of propofol in
adults, physicians at Oregon Health and Science University have been treating migraine headaches in children
with low-dose propofol since 2010. This retrospective
study compared the outcomes of seven of those children
with seven matched controls who received standard
abortive therapy, including nonsteroidal anti-inflamma-tory drugs, diphenhydramine and prochlorperazine.
Patients who received subanesthetic doses of propofol
were monitored by a nurse and a physician credentialed
for deep sedation. The average dose was 1.71
milligrams/kilogram (mg/kg) divided over an average of
three boluses (the dose for procedural sedation ranges
from 3. 3 to 3. 5 mg/kg).
Results showed that the propofol group had signifi-
Misperceptions about
ADHD common among
parents, adolescents
◆ Bussing R, et al. J Adolesc Health. 2012;
51:593-600.
A subanesthetic dose of propofol is a promising abortive
treatment for migraine headache in the pediatric emergency department.
cantly greater reduction in pain scores from presentation
to discharge compared with controls (80% vs. 61%
reduction), and four patients receiving propofol had
100% reduction in pain compared with two controls.
In addition, those receiving propofol had a shorter length
of stay than the control group after medication was
administered (122 minutes vs. 203 minutes).
The authors concluded that low-dose propofol is a
promising treatment for pediatric migraines, but prospective studies that compare propofol to standard treatment
are needed.
Test helps rule out inflammatory bowel disease in youths
◆ Van de Vijver E, et al. Arch Dis Child. 2012;97:
1014-1018.
Inflammatory bowel disease (IBD) can be ruled out
in pediatric patients who have a normal fecal calprotectin
level, making referral for endoscopy unnecessary, according to a study of 117 children in the Netherlands.
Determining whether to refer a child with recurrent
abdominal pain and diarrhea for endoscopy is difficult
for pediatricians. Many patients with symptoms of IBD
who undergo endoscopy do not have the disease.
A recent meta-analysis indicated that children most
likely to have IBD have increased levels of calprotectin,
a sensitive marker of intestinal inflammation, in the stool.
The authors of the meta-analysis conducted this prospective study to evaluate whether fecal calprotectin results
can be used to determine which children should be
referred for endoscopy without missing any cases of IBD.
Participants included 117 patients ages 6-18 years with
a clinical suspicion of IBD, including diarrhea for more
than four weeks or more than two episodes of diarrhea
and abdominal pain in six months. Stool samples were
collected from all patients, and fecal calprotectin was meas-
ured (cut-off point 50 µg/g stool). Pediatric gastroenterol-
ogists, who were not given test results, decided whether
to refer their patients for other testing, including endoscopy.
Although parents and teens often considered
themselves knowledgeable about attention-deficit/hyperactivity disorder (ADHD), one-quarter said ADHD is caused by sugar, and
most said medication is overused, according to
a survey of 374 adolescents and their parents.
The survey also showed that about half of
parents and teens preferred to get their information about ADHD from the Internet,
while 45% of parents and 27% of teens preferred talking with health professionals.
Many children with ADHD continue to
have symptoms into adolescence and young
adulthood, but they often discontinue treatment as they grow older. The authors of this
study noted that chronic illness management
models call for educating young patients
about their illness and how they can manage
it. They conducted this survey of adolescents
who were screened in 1998 for ADHD and
their parents to assess their knowledge and
perceptions of ADHD. Researchers also asked
teens and their parents where they prefer to
get and actually got their information about
the disorder.
Results showed that 93% of adolescents
had heard of ADHD, and 49% considered
themselves knowledgeable about the condition. Similarly, 98% of parents were familiar
with ADHD, while 78% considered themselves knowledgeable.
Both teens and parents had misconceptions
about the etiology and treatment of the disease: 27% of teens and 25% of parents
thought too much sugar in the diet was a
cause, and 67% of teens and 85% of parents
were concerned that doctors were giving too
many children medication for ADHD. Caucasian parents and teens had greater knowledge about ADHD than African-Americans.
About half of parents and adolescents got
their information about the disorder most
often from the Internet, teachers/school
and TV.
The authors concluded that doctors should
use the limited time available during visits to
provide culturally sensitive information on
ADHD to families, answer their questions
and steer them to reputable Internet sources.
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