25 Efficacy of oral metoclopramide for the treatment of migraine in children and youth in the emergency department: A retrospective study
Notice bibliographique
Résumé
Abstract Background Intravenous (IV) metoclopramide is commonly used as an acute treatment for migraine in children in the emergency department (ED). However, IV administration can be painful and distressing for children; alternative routes of administration should be considered if proven as effective. Oral metoclopramide has been suggested for the treatment of migraine in children based on limited evidence in adults use and pharmacokinetic similarities. Objectives This study aimed to assess the efficacy of oral metoclopramide for treating migraine in children in the ED. Design/Methods We conducted a retrospective cohort study in a tertiary care paediatric ED from September 2023 to September 2024, including children aged 8-18 years who received IV or oral metoclopramide for a migraine episode. The primary outcome was symptom relief, defined as the absence of rescue IV medication after the first dose of metoclopramide. Secondary outcomes included the ED length of stay, return visits within 7 days, and the difference in pain scores pre/post treatment using the verbal numeric scale. Patient identification was achieved using the computerized provider order entry system. A random sample of 10% of the charts was independently reviewed to assess inter-rater reliability. Results Of the 400 children who received metoclopramide in our ED during the study period, 226 met the inclusion criteria. Baseline demographics were similar between the IV and oral groups. The median age was 14 years old, with 69% female, 40% having a past medical history of migraine, and the median pain score prior to medication administration was 7 for both groups. Oral metoclopramide was administered to 78 (35%) children, of whom 83% (65/78) did not require additional treatment, compared to 79% (116/148) in the IV group. Median time spent in the ED was 314 minutes for the oral group versus 499 minutes for the IV group (difference 185; 95%CI: 25 to 268). Three patients were admitted, all in the IV group. 9 (12%) patients in the oral group returned within 7 days, compared to 14 (9%) in the IV group. The mean pain score following the first dose of medication was 2.6 in the oral group versus 1.9 in the IV group (difference 0.7; 95%CI: 0.2- 1.4). Conclusion This study demonstrated that over 80% of children receiving oral metoclopramide for migraine did not require rescue medication, highlighting its potential as a non-invasive and effective intervention for migraines in the paediatric ED. Additionally, these children had a median emergency department stay shorter. This approach could minimize procedural pain and reduce emergency room stays. As the first study evaluating oral metoclopramide for migraines in children, these findings warrant further investigation through a randomized clinical trial.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».