Resident Golisano Children's Hospital at The University of Rochester Medical Center Rochester, New York, United States
Background: Dexamethasone has become the standard of care for pediatric patients with status asthmaticus in the emergency department (ED) setting. Inpatient providers are often faced with the decision of continuing the ED’s second dose of dexamethasone or transitioning to prednisone. The effectiveness of receiving both dexamethasone and prednisone (combination therapy) compared to only prednisone or only dexamethasone remains unclear. Objective: We sought to evaluate and compare outcomes of dexamethasone, prednisone, and combination therapy for inpatient asthma management. Design/Methods: We conducted a retrospective study at a tertiary children’s hospital of children aged 2 to 18 years with a primary discharge diagnosis of asthma who were hospitalized between March 2016 to December 2018. Patients with a concurrent diagnosis of pneumonia, viral lower respiratory tract infection, bronchiolitis, medical complexity, and/or admitted to the pulmonary service were excluded. The Chi-square test, Kruskal-Wallis test and the Mann-Whitney test were used to examine the differences among the therapy groups. Results: A total of 1697 subjects met inclusion criteria. 115 (6.8%) patients received dexamethasone, 597 (35.2%) received prednisone, and 985 (58.0%) received combination therapy (Table 1). Patients prescribed combination therapy were more likely to have a lower exacerbation severity than patients prescribed prednisone alone and more severe than dexamethasone alone (p < 0.001) (Figure 1). Patients prescribed combination therapy were not more likely to have worse asthma control or baseline severity compared to patients prescribed dexamethasone (p>0.05). There were no significant differences in 30-day ED reutilizations or hospital readmissions when comparing steroid groups (p>0.05). Average length of stay was shortest among patients who received dexamethasone (p < 0.001) (Table 2).
Conclusion(s): Our study demonstrates no difference in 30-day ED reutilization or hospital readmission among hospitalized children receiving dexamethasone, prednisone, or combination therapy for asthma. Further studies comparing the outcomes of these three steroid groups are warranted.
