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Evaluation of Dexamethasone Dosing Strategies in Pediatric Asthma Exacerbations
Irene R Kelly1, Thomas Laudone1, Richard Lichenstein2
1School of Pharmacy, University of Maryland, Baltimore, MD (IRK, TL, KAP).
Insights
A standardized dose of dexamethasone for pediatric asthma exacerbations did not increase return visits but shortened hospital stays. This approach may improve adherence and offers favorable outcomes.
Area of Science:
- Pediatric Emergency Medicine
- Pulmonology
- Pharmacology
Background:
- Asthma exacerbations are a common reason for pediatric emergency department visits.
- Dexamethasone is a key corticosteroid used in treating pediatric asthma exacerbations.
- Current dosing strategies for dexamethasone vary, with some based on weight and others standardized.
Purpose of the Study:
- To compare health care utilization for pediatric asthma exacerbations treated with standardized-dose versus weight-based-dose dexamethasone.
- To evaluate the impact of different dexamethasone dosing strategies on patient outcomes and resource use.
Main Methods:
- Retrospective, single-center study of pediatric patients (2-17 years) with asthma exacerbations.
- Inclusion criteria: received dexamethasone, had asthma diagnosis (ICD-10 code).
- Primary outcome: 30- and 90-day return visits to the emergency department; secondary outcomes: hospitalization, intubation, length of stay, adverse events.
Main Results:
- No significant difference in 30- or 90-day return visits between standardized and weight-based dexamethasone groups.
- Standardized dosing group showed shorter length of stay and reduced use of ipratropium and magnesium.
- Hospitalization rates were lower in the weight-based group; adverse events (vomiting, hyperglycemia, hypertension) were similar across groups.
Conclusions:
- Standardized dexamethasone dosing in pediatric asthma exacerbations is associated with favorable outcomes, including shorter hospital stays.
- This strategy may simplify treatment and potentially improve adherence.
- Further research may be needed to fully elucidate hospitalization rate differences.
Objectives:
This study aimed to determine if there is a difference in health care use in pediatric asthma exacerbations with dexamethasone at a standardized dose compared with a weight-based approach. .
Methods:
This was a single-center, retrospective study of patients ages 2 to 17 years presenting to the pediatric emergency department (ED) with an asthma exacerbation between July 1, 2018, and June 30, 2021. Patients who received at least 1 dose of dexamethasone and had an International Classification of Diseases, 10th revision (ICD-10) code for asthma were included. The primary end point was the rate of return visits to the ED within 30 days and 31 to 90 days. Secondary end points included incidence of hospitalization and intubation, length of stay, dexamethasone dosing discrepancies, other corticosteroids or adjunctive therapies used, and medication escalation at discharge. The incidences of vomiting, hyperglycemia, and hypertension were also evaluated. Descriptive statistics were used for categoric variables and a Kaplan-Meier survival curve and Cox regression evaluated the primary outcome.
Results:
A total of 252 patients were included, 162 in the standardized dosing group and 90 in the weight-based group. There was no difference in return visits at 30 days and 31 to 90 days (3.1 vs 4.4, p = 0.58; and 3.7 vs 7.8, p = 0.16). The standardized group had a statistically significant shorter length of stay and lower ipratropium and magnesium use compared with the weight-based group. However, hospitalization rates were lower overall in the weight-based group. The incidences of vomiting, hyperglycemia, and hypertension were similar.
Conclusions:
A standardized dosing strategy for dexamethasone in pediatric asthma exacerbations showed favorable outcomes and may lead to improved adherence.
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