521 - Comparative effectiveness of corticosteroids for acute asthma treatment in the pediatric emergency department

Publication Number: 2506.521

Adjoa A. Andoh, Nationwide Children's Hospital, Westerville, OH, United States; Melisa Tanverdi, University of Colorado School of Medicine, Aurora, CO, United States; Daniel Shapiro, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Matthew J. Lipshaw, University of Michigan Medical School, Ann Arbor, MI, United States; Anna M. Cushing, Children's Hospital Los Angeles, Los Angeles, CA, United States; Cody S. Olsen, University of Utah, Salt Lake City, UT, United States; Huong Meeks, University of Utah, Kaysville, UT, United States; Kathryn Morris, University of Utah, Herriman, UT, United States; Julie Leonard, Nationwide Children's Hospital, Columbus, OH, United States; Joseph Zorc, Childrens Hospital of Philadelphia, Wynnewood, PA, United States

Background: Multiple systemic corticosteroid regimens are used in clinical practice to treat pediatric asthma exacerbations. However, there are limited multicenter studies comparing effectiveness of regimens in the emergency department (ED).

Objective: To evaluate the association between corticosteroid types and clinical outcomes for children treated for asthma exacerbations in the ED.

Design/Methods: We performed a retrospective cohort study of asthma ED encounters for children 2-17 years between January 2012 and November 2024. Data was obtained from 17 pediatric EDs in the Pediatric Emergency Care Applied Research Network Registry. We defined asthma visits as those with an ICD-10-CM diagnosis code for asthma or wheezing and receiving 2 or more albuterol treatments and enteral systemic corticosteroids in the ED. We excluded children with complex comorbid conditions, an asthma-related ED visit within the preceding 14 days, or when multiple corticosteroid types or a corticosteroid not of interest were prescribed. To assess the association between prescribed dexamethasone and hospitalization relative to prednisone/prednisolone/methylprednisolone, we used multivariable logistic regression to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI), additionally adjusting for age, sex, year, site, race and ethnicity, initial asthma severity, prior hospitalization, tachypnea, initial O2 saturation, and whether critical medications and intravenous magnesium were administered. We then repeated the analysis for patients discharged from the ED to determine the association between dexamethasone and return visit for asthma within 7 days.

Results: We identified 189,747 eligible ED encounters for asthma. Of these, 73.5% received a prescription for dexamethasone, while 26.5% were prescribed prednisone, prednisolone, or methylprednisolone. Hospital admission occurred in 60,228 encounters (31.7% overall), including 29.7% of those prescribed dexamethasone and 37.3% of those prescribed prednisone/prednisolone/methylprednisolone (aOR 0.45, 95% CI 0.43 - 0.47). Of 98,046 ED encounters discharged home with a dexamethasone prescription, 1.63% returned to the ED for asthma treatment within 7 days compared to 1.52% of those who were prescribed prednisone/prednisolone/methylprednisolone (aOR 1.43, 95% CI 1.21 - 1.69).

Conclusion(s): Enteral dexamethasone was associated with decreased risk of hospital admission, but with an increased risk of a return visit for asthma treatment. Future research should explore associations between various corticosteroid regimens and clinical outcomes.

Table 1: Association of Dexamethasone compared to prednisone/prednisolone/methylprednisolone with hospitalization and revisit rates within 7 days.
Results from logistic regression models with corticosteroid type as the independent variable (prednisone/prednisolone/methylprednisolone as reference). Covariates included: site, year, age, sex, race/ethnicity, initial asthma severity, prior hospitalization, tachypnea, initial O2 sats, critical meds (intramuscular epinephrine, intramuscular terbutaline, intravenous ketamine, intravenous theophylline/aminophylline), IV magnesium.