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Variation in Systemic Corticosteroid Prescribing for Asthma Exacerbations at Children's Hospitals
Siân Best1,2, Matt Hall1,3, Jessica L Bettenhausen1,2
1Division of Hospital Medicine, Children's Mercy Kansas City, Kansas City, Missouri.
Insights
Systemic corticosteroid prescribing for pediatric asthma hospitalizations shows increased dexamethasone use. Hospital-level prescribing patterns varied, but higher dexamethasone use did not correlate with different hospitalization outcomes.
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.
Background:
Asthma exacerbations are a leading cause of pediatric hospitalization, and systemic corticosteroids are a mainstay of inpatient treatment. This study describes hospital-level variability and trends in systemic corticosteroid prescribing during acute asthma exacerbation hospitalizations and examines hospital-level associations between prescribed corticosteroid and hospitalization outcomes.
Methods:
This retrospective cross-sectional study used the Pediatric Health Information System database to examine encounters of patients aged 2 to 18 years who were hospitalized with an acute asthma exacerbation between January 1, 2016, and December 31, 2023 and were administered dexamethasone, prednisone, prednisolone, or methylprednisolone. We analyzed trends and hospital-level variation in systemic corticosteroid prescribing. We used generalized estimating equations to analyze the association of annual hospital-level dexamethasone use with hospitalization outcomes-length of stay, ED revisit, and readmission rates, with models adjusted for relevant clinical and demographic factors.
Results:
We identified 122 856 asthma hospitalizations across 38 children's hospitals. From 2016 to 2023, the proportion of hospital-level dexamethasone use increased from 42% to 77%. The proportion of hospitals prescribing dexamethasone for over 80% of hospital encounters rose from 18% in 2016 to 66% in 2023. There was no difference in hospitalization outcomes based on annual hospital-level dexamethasone use, including a subanalysis also based on annual hospital-level dexamethasone use focusing on exclusive dexamethasone or exclusive prednisone/prednisolone use (P > .05).
Conclusions:
Dexamethasone use during asthma hospitalizations increased during the study period, without differences in hospitalization outcomes between hospitals that used a higher proportion of dexamethasone vs those that used less.
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