![Sample our Medicine, Dentistry, Nursing & Allied Health journals, sign in here to start your FREE access for 14 days]({"type":"image" , "src" : "/sda/5944/TOC-Subject-Sample-2021-Medicine-Dentistry-Nursing-Allied-Health.jpg"})
Abstract
Objectives
Dexamethasone has become the standard of care for pediatric patients with status asthmaticus in the emergency department (ED) setting. Inpatient providers often must decide between continuing the second dose of dexamethasone or transitioning to prednisone. The effectiveness of receiving dexamethasone followed by prednisone (combination therapy) compared to only prednisone or dexamethasone remains unclear. This study compares patient characteristics and ED reutilization/hospital readmission outcomes of dexamethasone, prednisone, and combination therapy for inpatient asthma management.
Methods
A retrospective study was conducted at our tertiary children’s hospital of children aged 2 to 18 years hospitalized between March 2016 and December 2018 with a primary discharge diagnosis of asthma, reactive airway disease, or bronchospasm. The differences between steroid groups were compared using Fisher’s exact or Chi-square tests for categorical variables, and a Kruskal-Wallis test for continuous variables. A multivariable logistic regression was performed to analyze ED reutilization and hospital readmission rates.
Results
1697 subjects met inclusion criteria. 115 (6.8%) patients received dexamethasone, 597 (35.2%) received prednisone, and 985 (58.0%) received combination therapy. Patients prescribed combination therapy had a lower exacerbation severity than patients prescribed prednisone, but higher severity than patients prescribed dexamethasone (p < .001, p = .001, respectively). Dexamethasone and combination therapy were not associated with increased 30-day ED reutilization/hospital readmissions compared to prednisone (p > .05).
Conclusions
In our study, most patients hospitalized for status asthmaticus received combination therapy. Despite the differences in severity between steroid groups, outcomes of combination therapy and dexamethasone monotherapy, as measured by frequency of ED reutilizations/hospital readmissions, are comparable to prednisone monotherapy.
Author contributions
Dr. Nelipovich contributed to the design of the study, data collection, analysis, and interpretation; drafted the initial manuscript; reviewed and revised the manuscript; and approved the final manuscript as submitted.
Drs. Vepraskas, Soung, and Pronko contributed to the design of the study; participated in data collection, analysis, and interpretation; critically reviewed and revised the manuscript; and approved the final manuscript as submitted.
Dr. Yan contributed to the design of the study; conducted analysis and interpretation of the data; critically reviewed and revised the manuscript; and approved the final manuscript as submitted.
Ms. Zhang contributed to the design of the study; conducted analysis and interpretation of the data; critically reviewed and revised the manuscript; and approved the final manuscript as submitted.
Ms. Porada contributed to the data acquisition; contributed to the revision process of this study; and approved the final manuscript as submitted.
Dr. Chou conceptualized and designed the study; contributed to development of the data collection; participated in data collection, analysis, and interpretation; critically reviewed and revised the manuscript; and approved the final manuscript as submitted.
Declaration of interest
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.