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Background: Asthma exacerbations are a leading cause of pediatric hospitalizations, and systemic corticosteroids remain a key component of inpatient treatment. Emergency department-focused studies have shown dexamethasone to be equivalent to prednisone/prednisolone in terms of outcomes such as readmission rates, but less is known about the trends in dexamethasone use versus other systemic corticosteroids, and associated outcomes in the inpatient setting. Objectives/Goal: To describe variability and trends in inpatient systemic corticosteroid prescribing practices for acute asthma exacerbations, and to determine associations between the prescribed steroid and hospitalization outcomes. Methods/Design: This retrospective cross-sectional study utilized the PHIS database to examine patients aged 2-18 years hospitalized with an acute asthma exacerbation/status asthmaticus between 01/01/2016-06/30/2023 that were administered dexamethasone, prednisone, prednisolone, or methylprednisolone. Patients with concurrent diagnoses of bronchiolitis, bacterial pneumonia, complex chronic conditions, or those who received other systemic corticosteroids were excluded. Children with more severe illness were excluded: patients with length of stay (LOS) >5 days, those who received mechanical ventilation, non-invasive ventilation, ECMO or CPR. Hospitals that did not consistently participate in PHIS throughout the study period were excluded. We used generalized estimating equations to analyze the association of annual hospital level dexamethasone use with hospitalization outcomes, with models adjusted for age, ICU stay, LOS, and illness severity (H-RISK). Results: There were 113,730 asthma hospitalizations identified across 37 hospitals. The proportion of encounters in which dexamethasone was administered increased from 43% to 76% from 2016 to 2023 (Fig 1). There was substantial variability in dexamethasone use across hospitals and years (Fig 2). The proportion of hospitals prescribing dexamethasone for >80% of hospitalization encounters rose from 18% of hospitals in 2016 to 60% in 2023. No difference in 7 or 30-day ED revisits, 7 or 30-day readmissions, or LOS were found based on annual hospital-level dexamethasone use, or between dexamethasone and prednisone/prednisolone usage (p>0.05). Conclusions: Dexamethasone use during asthma hospitalizations has steadily increased since 2016, without differences in readmissions or length of stay among hospitals. Substantial variation in inpatient dexamethasone use may reflect limited clinical trial data focused on children hospitalized with asthma, and its current exclusion from national guidelines.

Publication Date

8-2024

Disciplines

Pediatrics

When and Where Presented

Presented at the Pediatric Hospital Medicine Conference; Minneapolis, MN; August 1st-4th, 2024.

Variation in Systemic Corticosteroid Prescribing During Asthma-Related Hospitalizations Across Children’s Hospitals

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