Title

Comparative Effectiveness of Dexamethasone versus Prednisone in Children Hospitalized with Asthma.

Document Type

Article

Publication Date

9-2015

Identifier

DOI: 10.1016/j.jpeds.2015.06.038

Abstract

OBJECTIVES: To study the comparative effectiveness of dexamethasone vs prednisone/prednisolone in children hospitalized with asthma exacerbation not requiring intensive care.

STUDY DESIGN: This multicenter retrospective cohort study, using the Pediatric Health Information System, included children aged 4-17 years who were hospitalized with a principal diagnosis of asthma between January 1, 2007 and December 31, 2012. Children with chronic complex condition and/or initial intensive care unit (ICU) management were excluded. Propensity score matching was used to detect differences in length of stay (LOS), readmissions, ICU transfer, and cost between groups.

RESULTS: 40,257 hospitalizations met inclusion criteria; 1166 (2.9%) received only dexamethasone. In the matched cohort (N = 1284 representing 34 hospitals), the LOS was significantly shorter in the dexamethasone group compared with the prednisone/prednisolone group. The proportion of subjects with a LOS of 3 days or more was 6.7% in the dexamethasone group and 12% in the prednisone/prednisolone group (P = .002). Differences in all-cause readmission at 7- and 30 days were not statistically significant. The dexamethasone group had lower costs of index admission ($2621 vs $2838; P < .001) and total episode of care (including readmissions) ($2624 vs $2856; P < .001) compared with the prednisone/prednisolone group. There were no clinical significant differences in ICU transfer or readmissions between groups.

CONCLUSIONS: Dexamethasone may be considered an alternative to prednisone/prednisolone for children hospitalized with asthma exacerbation not requiring admission to intensive care.

Journal Title

The Journal of pediatrics

Volume

167

Issue

3

First Page

639

Last Page

644

MeSH Keywords

Adolescent; Asthma; Child; Child, Preschool; Cohort Studies; Dexamethasone; Female; Glucocorticoids; Hospitalization; Humans; Length of Stay; Male; Patient Readmission; Prednisone; Propensity Score; Retrospective Studies; United States

Keywords

Adolescent; Asthma; Child; Child, Preschool; Cohort Studies; Dexamethasone; Female; Glucocorticoids; Hospitalization; Humans; Length of Stay; Male; Patient Readmission; Prednisone; Propensity Score; Retrospective Studies; United States

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