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Comparative Effectiveness of Dexamethasone versus Prednisone in Children Hospitalized with Asthma

Kavita Parikh1, Matt Hall2, Vineeta Mittal3

  • 1Division of Hospital Medicine, Department of Pediatrics, Children's National Medical Center and George Washington School of Medicine, Washington, DC.

The Journal of Pediatrics
|August 31, 2015
PubMed

Insights

Dexamethasone significantly reduced length of stay and costs for children hospitalized with asthma exacerbation compared to prednisone/prednisolone. This suggests dexamethasone is a viable alternative for non-intensive care cases.

Area of Science:

  • Pediatric Emergency Medicine
  • Pharmacology
  • Clinical Effectiveness Research

Background:

  • Asthma exacerbations are a common reason for pediatric hospitalization.
  • Corticosteroids like prednisone/prednisolone and dexamethasone are standard treatments.
  • Comparative effectiveness data for these agents in non-intensive care settings is limited.

Purpose of the Study:

  • To compare the effectiveness of dexamethasone versus prednisone/prednisolone in children hospitalized with asthma exacerbation.
  • To evaluate differences in length of stay, readmissions, intensive care unit (ICU) transfer, and cost.

Main Methods:

  • Retrospective cohort study of children aged 4-17 years hospitalized with asthma.
  • Exclusion of patients with chronic complex conditions or requiring initial ICU management.
  • Propensity score matching to compare outcomes between dexamethasone and prednisone/prednisolone groups.

Main Results:

  • Dexamethasone use was associated with a significantly shorter length of stay (LOS) compared to prednisone/prednisolone.
  • The proportion of patients with LOS of 3 days or more was lower in the dexamethasone group (6.7% vs 12%).
  • Dexamethasone resulted in lower index admission and total episode of care costs, with no significant differences in readmissions or ICU transfer.

Conclusions:

  • Dexamethasone is a potentially effective alternative to prednisone/prednisolone for pediatric asthma exacerbations not requiring intensive care.
  • The findings support considering dexamethasone to potentially reduce healthcare resource utilization.
  • Further prospective studies could confirm these findings and explore optimal dosing strategies.
Abstract

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