Presenter Status
Fellow
Abstract Type
Clinical Research
Primary Mentor or Principal Investigator
Jessica Markham, MD, MSc
Presentation Type
Poster
Start Date
20-5-2026 12:00 PM
End Date
20-5-2026 1:00 PM
Abstract Text
Background: Systemic corticosteroids (SCS) are a cornerstone of treatment for acute asthma exacerbation. However, the role of SCS in preschool-aged children hospitalized with viral respiratory tract infection (vRTI), including viral induced wheezing, remains uncertain. Clinical trials have reported conflicting results about the benefits of SCS in this population.
Objectives: To evaluate hospital-level variation in inpatient management of preschool-aged children admitted with vRTI and to compare clinical and utilization outcomes based on hospital-level SCS use.
Methods: We conducted a retrospective cohort study of children aged 24-59 months admitted to US children’s hospitals with vRTI from July 2022-July 2024 using the Pediatric Health Information System. We excluded encounters with complex chronic conditions, intensive care unit stays, bacterial RTIs (e.g., pneumonia, pertussis) and vRTI treated with SCS (e.g., croup, COVID-19). We calculated hospital-level proportion of encounters receiving SCS (including methylprednisolone, prednisone, prednisolone, dexamethasone), albuterol on ≥1 day, and inhaled corticosteroids (ICS). We grouped hospitals into quartiles based on the proportion of encounters receiving SCS. Generalized estimating equations were used to compare length of stay (LOS), ED revisits, readmissions, and costs between low SCS (1st quartile) and high SCS (4th quartile) hospitals, adjusting for age, sex, payor, illness severity, and asthma diagnosis.
Results: We identified 44,848 vRTI encounters across 46 hospitals; 42.4% had an asthma diagnosis. On average, 55% of encounters received SCS (range: 39%-60%), 32.2% received ≥1 day of albuterol (range: 7%-56%), and 19.3% received ICS (range: 3%-37%) (Fig. 1). A positive correlation existed between hospital-level proportion of encounters receiving ≥1 day albuterol and hospital-level SCS use (Pearson’s r =0.52, p< 0.001) (Fig. 2). In unadjusted analyses, only 7-day revisit rates differed between low SCS hospitals (revisit rate=2.0%) and high SCS hospitals (revisit rate 1.6; p=0.014). In adjusted analyses, hospitals with low and high SCS use had similar LOS, ED revisits, readmissions, and costs (Table 1).
Conclusions: Substantial hospital-level variation exists in use of SCS and albuterol among preschool-aged children hospitalized for vRTI. Hospitals with higher SCS use had similar outcomes compared to those with lower use. Our findings suggest potential overuse of SCS and highlight the need for more evidence to guide appropriate SCS use in preschool aged vRTI.
Does Variation in Systemic Steroid Use Impact Outcomes in Preschoolers Hospitalized with Viral Respiratory Tract Infection?
Background: Systemic corticosteroids (SCS) are a cornerstone of treatment for acute asthma exacerbation. However, the role of SCS in preschool-aged children hospitalized with viral respiratory tract infection (vRTI), including viral induced wheezing, remains uncertain. Clinical trials have reported conflicting results about the benefits of SCS in this population.
Objectives: To evaluate hospital-level variation in inpatient management of preschool-aged children admitted with vRTI and to compare clinical and utilization outcomes based on hospital-level SCS use.
Methods: We conducted a retrospective cohort study of children aged 24-59 months admitted to US children’s hospitals with vRTI from July 2022-July 2024 using the Pediatric Health Information System. We excluded encounters with complex chronic conditions, intensive care unit stays, bacterial RTIs (e.g., pneumonia, pertussis) and vRTI treated with SCS (e.g., croup, COVID-19). We calculated hospital-level proportion of encounters receiving SCS (including methylprednisolone, prednisone, prednisolone, dexamethasone), albuterol on ≥1 day, and inhaled corticosteroids (ICS). We grouped hospitals into quartiles based on the proportion of encounters receiving SCS. Generalized estimating equations were used to compare length of stay (LOS), ED revisits, readmissions, and costs between low SCS (1st quartile) and high SCS (4th quartile) hospitals, adjusting for age, sex, payor, illness severity, and asthma diagnosis.
Results: We identified 44,848 vRTI encounters across 46 hospitals; 42.4% had an asthma diagnosis. On average, 55% of encounters received SCS (range: 39%-60%), 32.2% received ≥1 day of albuterol (range: 7%-56%), and 19.3% received ICS (range: 3%-37%) (Fig. 1). A positive correlation existed between hospital-level proportion of encounters receiving ≥1 day albuterol and hospital-level SCS use (Pearson’s r =0.52, p< 0.001) (Fig. 2). In unadjusted analyses, only 7-day revisit rates differed between low SCS hospitals (revisit rate=2.0%) and high SCS hospitals (revisit rate 1.6; p=0.014). In adjusted analyses, hospitals with low and high SCS use had similar LOS, ED revisits, readmissions, and costs (Table 1).
Conclusions: Substantial hospital-level variation exists in use of SCS and albuterol among preschool-aged children hospitalized for vRTI. Hospitals with higher SCS use had similar outcomes compared to those with lower use. Our findings suggest potential overuse of SCS and highlight the need for more evidence to guide appropriate SCS use in preschool aged vRTI.
Comments
Poster Board Number: 20