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Dexamethasone Versus Prednisone in Children Hospitalized With Asthma Exacerbation
Erik R Hoefgen1, Bin Huang2,3, Christine L Schuler2,4,5
1Division of Hospitalist Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.
Insights
For hospitalized children with asthma, dexamethasone and prednisone show similar effectiveness in preventing 30-day reutilization. This study compared these common corticosteroid treatments for pediatric asthma exacerbations.
Area of Science:
- Pediatric Pulmonology
- Clinical Pharmacology
- Health Services Research
Background:
- Dexamethasone is increasingly used for pediatric asthma hospitalizations, often replacing prednisone.
- Limited data exist on dexamethasone's effectiveness compared to prednisone in severe pediatric asthma exacerbations requiring hospitalization.
Purpose of the Study:
- To compare the effectiveness of dexamethasone versus prednisone in children hospitalized with asthma exacerbations.
- To evaluate the impact of initial corticosteroid choice on 30-day reutilization rates.
Main Methods:
- Retrospective cohort study of 1161 children (aged 4-17) hospitalized with asthma.
- Covariate-balanced propensity score and inverse probability treatment weighting used to adjust for steroid selection bias.
- 30-day reutilization (unplanned readmission or ED visit) was the primary outcome.
Main Results:
- Dexamethasone was the initial steroid for 44% of patients; prednisone for 56%.
- Return utilization was 3.9% for dexamethasone vs. 2.2% for prednisone.
- Propensity score-adjusted analysis found no significant difference in 30-day reutilization between the two corticosteroid groups (aOR 1.61).
Conclusions:
- The initial choice between dexamethasone and prednisone was not associated with significant differences in 30-day reutilization after hospitalization for pediatric asthma exacerbation.
- Findings suggest comparable effectiveness for both corticosteroids regarding short-term re-visits.
Objectives:
Dexamethasone is increasingly used for the management of children hospitalized with asthma in place of prednisone, yet data regarding the effectiveness of dexamethasone in children with asthma exacerbation severe enough to require hospitalization are limited. Our objective is to compare the effectiveness of dexamethasone versus prednisone in children hospitalized with an asthma exacerbation on 30-day reutilization.
Methods:
We conducted a retrospective cohort study at an urban, quaternary children's hospital of children aged 4 to 17 years, hospitalized from January 1, 2014 to December 31, 2017, with a primary discharge diagnosis of asthma. A covariate-balanced propensity score was derived to account for physician discretion in steroid selection. A generalized linear model, including inverse probability treatment weighting, was used to detect differences in 30-day return utilization (unplanned readmission or emergency department visit) between children whose first dose of corticosteroid was dexamethasone versus prednisone.
Results:
Inclusion criteria were met by 1161 patients, of which 510 (44%) first received dexamethasone versus 651 (56%) who first received prednisone. The total cohort had a mean age of 8.5 years (SD 3.4). The covariate-balanced cohort had no significant differences in demographic characteristics or illness severity between groups. The dexamethasone group had a return utilization of 3.9% (20 of 510) versus 2.2% (14 of 651) for children treated with prednisone. The propensity score-adjusted analysis revealed the steroid treatment was not found to significantly affect the 30-day reutilization (adjusted odds ratio [aOR] 1.61; 95%CI 0.80-3.31).
Conclusions:
The initial steroid choice (dexamethasone versus prednisone) was not associated with 30-day reutilization after hospitalization for an asthma exacerbation.
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