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Variations in Corticosteroids Used for Asthma Exacerbations in the Pediatric Emergency Department: A Pediatric
Adjoa A Andoh1, Melisa S Tanverdi2, Daniel J Shapiro3
1Department of Pediatrics, Division of Emergency Medicine, Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus, Ohio.
Insights
Systemic corticosteroid use for pediatric asthma exacerbations varies. Enteral dexamethasone is increasingly used, with administration linked to patient sociodemographic and clinical factors.
Area of Science:
- Pediatric Emergency Medicine
- Pharmacology
- Health Services Research
Background:
- Systemic corticosteroids are standard for asthma exacerbations.
- Lack of consensus guidelines leads to varied treatment approaches.
Purpose of the Study:
- Examine trends in corticosteroid regimens for pediatric asthma exacerbations (2012-2024).
- Identify patient characteristics associated with specific corticosteroid administration.
Main Methods:
- Retrospective cohort study of 206,388 pediatric asthma exacerbation encounters (ages 2-17).
- Analysis of corticosteroid types administered across 17 clinical sites.
- Multivariable logistic regression to compare enteral dexamethasone vs. enteral prednisone.
Main Results:
- Enteral dexamethasone use increased significantly over the study period (69.5% overall).
- Younger age, Hispanic ethnicity, Spanish language, and public insurance were associated with dexamethasone.
- Prednisone use was linked to lower triage acuity, overweight status, moderate severity, and tachypnea.
Conclusions:
- Enteral dexamethasone use for pediatric asthma exacerbations has risen.
- Corticosteroid choice is influenced by patient sociodemographic and clinical factors.
- Further research needed on comparative effectiveness of different corticosteroid regimens.
Background:
Systemic corticosteroids are a standard part of treatment for asthma exacerbations. Multiple options for administration exist without consensus recommendations, leading to variability in treatment regimens across sites.
Objective:
To examine variations in corticosteroid regimens used to treat pediatric asthma exacerbations from 2012 to 2024 and identify sociodemographic and clinical characteristics associated with the type of corticosteroid administered.
Methods:
We performed a retrospective cohort study of encounters of children aged 2 to 17 years with asthma exacerbations using the Pediatric Emergency Care Applied Research Network Registry. Frequencies of corticosteroid types administered by site were summarized using median and interquartile ranges. Multivariable logistic regression compared treatment with enteral dexamethasone versus enteral prednisone by sociodemographic and clinical characteristics, adjusting for year and clinical site.
Results:
The analysis included 206,388 encounters over 17 sites. Overall, 69.5% of encounters received enteral dexamethasone, 24.7% enteral prednisone or prednisolone, 4.8% intramuscular or intravenous methylprednisolone, and 1.0% intramuscular or intravenous dexamethasone. There was an increase in the proportion of patients receiving enteral dexamethasone at sites throughout the study period (P < .001). Patients with younger age, Hispanic race and ethnicity, Spanish language, and public insurance or self-pay were more likely to receive enteral dexamethasone. Encounters with emergency severity index triage level 1 or 2, moderate exacerbation severity, tachypnea, or who were overweight, were more likely to receive prednisone.
Conclusions:
Use of enteral dexamethasone in the management of asthma exacerbations has increased over time, and the type of corticosteroid administered varied by sociodemographic and clinical characteristics. Future studies should explore the comparative effectiveness of different corticosteroid regimens on clinical outcomes.
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