Parental management of adrenal crisis in children with congenital adrenal hyperplasia.
Louise Fleming, Kathleen Knafl, George Knafl and 1 others
PMID 28771930WHAT IT FOUND
Parents who had been shown how to give a child's emergency hydrocortisone injection reported better management ability.
Crisis frequency decreased after age 5. One-time teaching may not be enough.
Key findings
01Parents who had been directly shown how to administer the emergency hydrocortisone injection reported higher management ability.
02Parents reported 0.77 adrenal crisis events per year in the first 5 years and 0.27 per year after age 5.
03Four parents said one-time injection instruction was insufficient for feeling confident in managing an adrenal crisis.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Parents were recruited through a CAH support organization, so they may have been more motivated to learn about the condition than other parents. The sample was mostly Caucasian, parents of adolescents were underrepresented, and families without computer access or English-speaking parents were not included. The study found associations between provider demonstration, child age, management ability, and family impact; it did not prove that injection teaching caused better management. Crisis counts came from parent reports grouped into categories, and the analysis used minimum events per year, so exact rates are approximate. Phase 2 interviews included 16 parents, so themes describe these families, not all families with CAH.
Declared interests
The authors reported no actual or potential conflicts of interest.
The easy way to misread this
Do not conclude that a single injection demonstration makes parents safer. The study only found that parents who had been shown how to give the injection reported higher management ability; it did not show that teaching caused better outcomes, and some parents said one-time teaching was not enough.