Variation in Systemic Corticosteroid Prescribing for Asthma Exacerbations at Children's Hospitals.
Document Type
Article
Publication Date
1-2026
Identifier
DOI: 10.1542/hpeds.2024-008228
Abstract
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.
Journal Title
Hosp Pediatr
Volume
16
Issue
1
First Page
8
Last Page
17
MeSH Keywords
Humans; Asthma; Child; Male; Female; Retrospective Studies; Cross-Sectional Studies; Hospitals, Pediatric; Adolescent; Child, Preschool; Practice Patterns, Physicians'; Hospitalization; Adrenal Cortex Hormones; Dexamethasone; Glucocorticoids; Drug Prescriptions; Patient Readmission
PubMed ID
41325986
Keywords
Asthma; Retrospective Studies; Cross-Sectional Studies; Pediatric Hospitals; Physicians' Practice Patterns; Hospitalization; Adrenal Cortex Hormones; Dexamethasone; Glucocorticoids; Drug Prescriptions; Patient Readmission
Recommended Citation
Best S, Hall M, Bettenhausen JL, et al. Variation in Systemic Corticosteroid Prescribing for Asthma Exacerbations at Children's Hospitals. Hosp Pediatr. 2026;16(1):e8-e17. doi:10.1542/hpeds.2024-008228
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