TOP 49 - Is One Enough? Single vs. Double Dexamethasone Dosing in Inpatient Pediatric Asthma Exacerbations

Publication Number: 2801.TOP 49

Raga S. Kilaru, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Jason T. Tsichlis, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Krishna A. Trivedi, Northwestern University - Lurie Children's Hospital, Chicago, IL, United States; Benjamin Traisman, Ann & Robert H. Lurie Children's Hospital of Chicago, Glen Ellyn, IL, United States; Sonia Parikh, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Emily Bowen, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Brittany Hunter, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Background: Asthma exacerbations remain one of the leading admission diagnoses for pediatric patients with systemic corticosteroids as the cornerstone of therapy. Dexamethasone is an increasingly popular choice, with a recent study noting 52.7% of encounters using it for systemic therapy. While studies have noted equivalency between two dexamethasone doses and 3–5-day prednisone course and single vs double dose dexamethasone in the emergency department setting, none have compared single vs double dose dexamethasone regimens in the inpatient setting.

Objective: We will perform a retrospective cohort analysis to evaluate the efficacy of single versus double dexamethasone dosing on length of stay (LOS) and 30-day readmissions among pediatric inpatients with asthma.

Design/Methods: A retrospective chart review of all patients admitted to the general medicine service with a primary diagnosis of asthma (approximately 2,500 encounters) from September 2017 to October 2025 has been completed. Patients were characterized into those that received a single dose of dexamethasone either oral, IM or IV (up to a total of 0.6mg/kg) and those that received 2 or more doses of dexamethasone during their hospitalization. Those that received systemic corticosteroids other than dexamethasone, or who required non-invasive positive pressure ventilation were excluded. We will also compare patient demographics and initial pediatric asthma scores between both groups. Outcome measures of 30-day same cause readmission rates and LOS will be compared between single and double dexamethasone dosing. Statistical analyses will compare length of stay and 30-day readmission rates between single- and multiple-dose groups using t-tests or chi-square tests, as appropriate. We anticipate that single-dose dexamethasone will demonstrate comparable efficacy with similar LOS and readmission rates.