Variation in Systemic Corticosteroid Prescribing for Asthma Exacerbations at Children's Hospitals

Area of Science:

• Pediatric Pulmonology
• Hospital Quality Improvement
• Pharmacotherapy Research

Background:

• Asthma exacerbations are a primary cause of pediatric hospitalizations, with systemic corticosteroids as a standard treatment.
• Significant variability exists in how hospitals prescribe these crucial medications during acute asthma events.
• Understanding prescribing trends and their impact on patient outcomes is vital for optimizing care.

Purpose of the Study:

• To analyze trends and hospital-level variations in systemic corticosteroid prescribing for pediatric asthma hospitalizations.
• To investigate the association between hospital-level dexamethasone use and key hospitalization outcomes.
• To identify potential improvements in treatment protocols for acute asthma exacerbations.

Main Methods:

• Retrospective analysis of 122,856 pediatric asthma hospitalizations (ages 2-18) from 2016-2023 using the Pediatric Health Information System database.
• Examined prescribing trends of dexamethasone, prednisone, prednisolone, and methylprednisolone.
• Generalized estimating equations were used to assess the link between annual hospital-level dexamethasone use and length of stay, ED revisits, and readmission rates, controlling for clinical and demographic factors.

Main Results:

• Dexamethasone use increased significantly, from 42% in 2016 to 77% in 2023 across 38 children's hospitals.
• The proportion of hospitals with over 80% dexamethasone use rose from 18% to 66% during the study period.
• No statistically significant differences in hospitalization outcomes (length of stay, ED revisit, readmission) were found based on hospital-level dexamethasone prescribing rates.

Conclusions:

• Hospital-level prescribing of dexamethasone for pediatric asthma exacerbations has markedly increased between 2016 and 2023.
• Despite increased dexamethasone use, there was no observed association with improved or worsened hospitalization outcomes.
• These findings suggest that while prescribing patterns are shifting, the choice of corticosteroid at the hospital level does not appear to impact key outcomes.