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Managing Pediatric Asthma Exacerbations: The Role of Timely Systemic Corticosteroid Administration in Emergency Care
Luna Antonino1,2, Eva Goossens2,3,4, Josefien van Olmen5
1Laboratory of Experimental Medicine and Pediatrics, Department of Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium.
Insights
Most children with asthma exacerbations in the emergency department do not receive timely systemic corticosteroids (SCS). Delayed SCS administration correlates with longer hospital stays and increased oxygen therapy needs in pediatric asthma patients.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Medicine
- Clinical Pharmacology
Background:
- Asthma is a leading chronic respiratory illness in children.
- Asthma exacerbations (AE) frequently lead to emergency department (ED) visits.
- Prompt systemic corticosteroids (SCS) administration is crucial for managing moderate to severe AE.
Purpose of the Study:
- To evaluate the timing of SCS administration in pediatric AE.
- To correlate SCS timing with length of stay and oxygen therapy duration.
- To identify predictors of timely SCS administration.
Main Methods:
- Retrospective, multicenter observational study.
- Included children under 18 with moderate to severe AE.
- Data extracted from electronic medical records.
Main Results:
- Only 28 out of 205 patients received SCS within 60 minutes.
- Median time to SCS was 169 minutes.
- Delayed SCS correlated with longer oxygen therapy (r=0.363) and hospital stay (r=0.368).
Conclusions:
- A significant majority of pediatric AE cases did not receive timely SCS.
- Delayed SCS administration is linked to poorer outcomes, including extended hospital stay and oxygen support.
- No patient characteristics predicted timely SCS administration in this cohort.
Background:
Asthma is the most prevalent chronic respiratory condition in children. An asthma exacerbation (AE) is a frequent reason for emergency department (ED) visits. An important step in the management of a moderate to severe AE is the administration of systemic corticosteroids (SCS) within 1 h after ED presentation. This study aimed to determine the timing of SCS administration and correlate this with the length of stay and oxygen therapy duration and to explore factors predicting timely administration.
Methods:
This study used a retrospective multicenter observational design based on electronic medical records review. Children aged < 18 years, presenting to the ED with a moderate to severe AE were included.
Results:
205 patients were included. Only 28 patients received SCS within 60 min after ED arrival. The median time to SCS administration was 169 min (Q1 92-Q3 380). A correlation was found between timing and oxygen treatment duration (r = 0.363, p < 0.001) and length of stay (r = 0.368, p < 0.001). No patient characteristics predicted timely SCS administration.
Conclusions:
Three in four children who presented with a moderate to severe AE at the ED did not receive SCS within the first hour. A prolonged timing of SCS administration correlated with a prolonged length of stay and extended need for oxygen support.
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