574 - Variation in Inpatient Management of Viral Respiratory Tract Infections in Preschool-Aged Children

Publication Number: 2559.574

Smit Shah, Children's Mercy Hospitals and Clinics, kansas city, MO, United States; Kathryn E.. Kyler, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Matt hall, Children's Hospital Association, Lenexa, KS, United States; Jessica Markham, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States

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.

Objective: 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.

Design/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).

Conclusion(s): 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.

Figure 1
Proportions of vRTI encounters for preschool-aged children receiving ≥1 day of albuterol, systemic corticosteroids (SCS), and inhaled corticosteroids (ICS).

Figure 2
Individual hospitals show positive correlation between proportions of children receiving systemic corticosteroids (SCS) and ≥1 day of albuterol in preschool children admitted with vRTI (Pearson's r = 0.52, p < 0.001).

Table 1
Unadjusted and adjusted models comparing outcomes between hospitals with low (n=12) and high (n=12) systemic corticosteroid use. H-RISK is an administrative illness severity index.