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Outcomes for Pediatric Asthmatic Inpatients After Implementation of an Emergency Department Dexamethasone Treatment

Amy Tyler1,2, Jillian M Cotter3,2, Angela Moss4

  • 1Children's Hospital Colorado, Aurora, Colorado; amy.tyler@childrenscolorado.org.

Hospital Pediatrics
|January 24, 2019
PubMed

Insights

Dexamethasone did not immediately improve outcomes for hospitalized asthma patients. However, its adoption was associated with an increasing trend in intensive care unit transfers.

Area of Science:

  • Pulmonology
  • Clinical Pharmacology

Background:

  • Dexamethasone is effective for mild-to-moderate asthma exacerbations in emergency departments.
  • The comparative effectiveness of dexamethasone versus prednisone for hospitalized asthma patients remains unclear.

Purpose of the Study:

  • To compare outcomes for hospitalized asthma patients before and after adopting dexamethasone in the emergency department.

Main Methods:

  • Single-center retrospective cohort study using interrupted time series analysis.
  • Evaluated length of stay, hospital charges, and ICU transfer rates over 36 months.
  • Compared 606 patients (prednisone) to 409 patients (dexamethasone or combination).

Main Results:

  • No significant immediate differences in length of stay or total charges were observed.
  • No immediate difference in ICU transfer rates was found (P = .98).
  • A significant monthly increase in ICU transfers was observed post-dexamethasone adoption (OR = 1.10, P = .02).

Conclusions:

  • Dexamethasone did not immediately alter hospitalization outcomes for asthma patients.
  • An increasing trend in ICU transfers was noted after dexamethasone became the preferred steroid.
Abstract

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