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Published on: February 2, 2017
Obesity and Corticosteroid Dosing Guideline Adherence in Children Hospitalized With Asthma
Kathryn E Kyler1,2, Jessica L Bettenhausen3,2, Matt Hall3,4
1Children's Mercy Hospital, Kansas City, Missouri; kekyler@cmh.edu.
Insights
Systemic corticosteroid orders were frequently nonadherent to guidelines in children hospitalized for asthma, with higher rates in those with obesity. Standardizing dosing for pediatric obesity is crucial to reduce harm.
Area of Science:
- Pediatric Pulmonology
- Clinical Pharmacology
- Health Outcomes Research
Background:
- Limited drug dosing recommendations exist for children with obesity.
- Variability in medication dosing can occur in pediatric populations with obesity.
- Asthma hospitalizations in children necessitate appropriate systemic corticosteroid use.
Purpose of the Study:
- To determine differences in the prevalence of guideline-nonadherent systemic corticosteroid orders by weight category in children hospitalized for asthma.
- To investigate the association between weight category and corticosteroid dosing adherence.
- To highlight the need for standardized dosing guidelines for pediatric obesity.
Main Methods:
- Retrospective cross-sectional study of children (2-17 years) hospitalized with asthma and prescribed systemic corticosteroids (2010-2017).
- Weight categories defined by BMI percentiles (CDC guidelines); corticosteroid orders assessed for adherence to NHLBI total body weight-based dosing guidelines.
- Statistical analysis included chi-squared tests and multivariable logistic regression.
Main Results:
- 21,488 children were included; 23.8% had obesity, and 54.2% had healthy weight.
- 22.2% of children received guideline-nonadherent corticosteroid orders.
- Prevalence of nonadherent orders increased with weight category (19.4% healthy weight vs. 36.0% class III obesity; P < .001), remaining significant after covariate adjustment (P < .001).
Conclusions:
- Guideline-nonadherent corticosteroid orders for pediatric asthma hospitalizations increase linearly with weight category.
- Children with severe obesity are disproportionately affected by nonadherent dosing.
- Standardizing drug dosing guidelines for pediatric obesity is essential to minimize variability and potential harm.
Objectives:
Drug dosing recommendations for children with obesity remain limited. This may lead to variability in medication dosing among children with obesity. Therefore, our objective was to determine differences in the prevalence of guideline-nonadherent systemic corticosteroid orders by weight category in children hospitalized for asthma.
Methods:
We performed a retrospective cross-sectional study of children aged 2 to 17 years hospitalized with asthma and prescribed systemic corticosteroids between January 1, 2010, and December 31, 2017, using the Cerner Health Facts deidentified database. Weight categories ranging from underweight to class III obesity were defined on the basis of BMI percentiles by using CDC guidelines. Corticosteroid orders were categorized as guideline adherent or nonadherent on the basis of total body weight-based dosing guidelines from the National Heart, Lung, and Blood Institute. χ2 test and multivariable logistic regression models were used to determine differences in guideline adherence between weight categories.
Results:
We identified 21 488 children prescribed systemic corticosteroids during asthma hospitalizations. Most (54.2%) had a healthy weight, and 23.8% had obesity. Almost one-quarter received guideline-nonadherent orders (22.2%), with increasing prevalence among higher weight categories (19.4% of healthy weight children versus 36.0% of those with class III obesity; P < .001). After controlling for demographic and clinical covariates, weight category remained significantly associated with receiving a guideline-nonadherent order (P < .001).
Conclusions:
The prevalence of guideline-nonadherent corticosteroid orders for children hospitalized with asthma increases linearly with weight category, disproportionately affecting children with severe obesity. Standardization of drug dosing guidelines for children with obesity may help reduce variability in drug doses prescribed that may increase risk of harm.
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