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Published on: February 25, 2022
Intravenous Dexamethasone Use and Outcomes in Children Hospitalized With Septic Arthritis
Andrew S Kern-Goldberger1, Matthew Hall2, Marcos Mestre3
1Division of Pediatric Hospital Medicine, Cleveland Clinic Children's Hospital and Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio.
Insights
Systemic corticosteroids like dexamethasone may improve outcomes for children with septic arthritis. This study found dexamethasone associated with shorter hospital stays and lower costs, without increasing readmissions.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Pharmacology
- Health Services Research
Background:
- Septic arthritis treatment typically involves joint drainage and antibiotics.
- Systemic corticosteroids are being explored as an adjunctive therapy to improve patient outcomes.
- Understanding the use and impact of dexamethasone in pediatric septic arthritis is crucial.
Purpose of the Study:
- To describe the variation in intravenous dexamethasone administration among children hospitalized with septic arthritis.
- To evaluate the association between intravenous dexamethasone use and clinical outcomes in this patient population.
Main Methods:
- Retrospective cohort study utilizing the Pediatric Health Information System database.
- Identified children with septic arthritis (ICD-10 code M00.x) and recorded intravenous dexamethasone use (hospital days 0-2).
- Propensity score matching was employed to control for confounding variables between dexamethasone recipients and non-recipients.
Main Results:
- Dexamethasone use varied significantly across hospitals (median 28%).
- In propensity-matched analysis, dexamethasone was linked to shorter hospital length of stay (LOS) and reduced costs.
- Increased opioid use was observed with dexamethasone, but no significant differences in 30-day revisits, postdrainage imaging, or repeat procedures were found.
Conclusions:
- Intravenous dexamethasone in children with septic arthritis is associated with reduced hospital LOS and costs.
- The benefits were observed without an increase in 30-day readmission rates.
- Further investigation via a multicenter randomized trial is warranted to confirm these findings.
Background:
Septic arthritis is routinely treated with joint drainage and antibiotics; however, adjunctive systemic corticosteroids may improve outcomes.
Objectives:
To (1) describe variation in intravenous dexamethasone use and (2) evaluate the association of intravenous dexamethasone use with outcomes among children hospitalized with septic arthritis.
Methods:
This is a retrospective cohort study of hospitalized children using the Pediatric Health Information System database. We identified intravenous dexamethasone use (on hospital days 0-2) in children with an International Classification of Diseases, Tenth Revision discharge code for septic arthritis (M00.x). The primary outcome was hospital length of stay (LOS). Secondary outcomes included costs, postdrainage imaging, opioid use, repeat drainage procedures, and 30-day emergency department or hospital revisits. We used propensity score matching to account for measured differences between dexamethasone recipients and nonrecipients.
Results:
We identified 3524 hospitalizations across 47 hospitals from 2016 to 2020. The median rate of dexamethasone use across hospitals was 28% (IQR, 19%-44%). In the propensity-matched cohort, dexamethasone was associated with shorter LOS (100.5 vs 114.3 hours, P < .001) and lower costs ($16 660 vs $18 243, P = .01) but greater opioid use (odds ratio [OR], 3.80; 95% CI, 1.49-9.70; P < .01). There were no significant differences in 30-day revisits (OR, 0.97; 95% CI, 0.73-1.29; P = .84), postdrainage computed tomography or magnetic resonance imaging (OR, 0.91; 95% CI, 0.71-1.15; P = .42), or repeat drainage procedures (OR, 1.01; 95% CI, 0.81-1.25; P = .94).
Conclusion:
In this large cohort study, children with septic arthritis receiving dexamethasone had shorter hospital LOS and costs without higher 30-day revisit rates. Dexamethasone use varied widely across hospitals. These findings highlight the need for evaluation in a multicenter randomized trial.
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