PURPOSE OF THE STUDY.
To determine if early treatment with oral corticosteroids to pediatric patients with asthma exacerbations in the emergency department could decrease their length of stay.
Children between the ages of 2 and 18 years who presented to the emergency department with acute asthma exacerbations and received oral corticosteroids, either prednisolone or dexamethasone, were included.
Retrospective chart review of 882 children who were seen over the 12-month study period was performed. A standardized asthma treatment algorithm was used as a guide based on severity of exacerbation, but the treating physician decided medications used. Timing of corticosteroid administration and length of stay was calculated by the electronic medical record. Children receiving corticosteroids within 60 minutes of triage were compared with those receiving corticosteroids ≥61 minutes after triage. The 2 groups were compared using either Student’s t test or χ2 test, based on the level of measurement.
Children treated with corticosteroids within 60 minutes had a mean length of stay of 157 minutes, whereas children treated later than 60 minutes had a mean length of stay of 182 minutes (P < .0001). The greatest decrease in length of stay was among children who were categorized as having a moderate exacerbation and had a mean 38-minute decrease in length of stay if treated with corticosteroids in the first hour. Both study groups had similar baseline characteristics; however, the group receiving corticosteroids within 60 minutes had a higher percentage of severe exacerbations. Subjects who received dexamethasone had a 19-minute shorter length of stay compared with patients treated with prednisolone. Of the subjects treated with dexamethasone, those who received it in the first 60 minutes had a mean 34-minute decrease in length of stay compared with those treated with prednisolone. Early treatment with albuterol within 60 minutes or after did not affect length of stay.
Early corticosteroid administration within 60 minutes of triage in pediatric patients with asthma exacerbations was associated with a significant decrease in the overall length of stay. This study suggested that choice of oral corticosteroid, dexamethasone over prednisolone, may also affect the length of stay.
Previous studies have found early corticosteroid administration to lessen admission rates to the hospital. Although this study did not show a difference in admission rates, this study did support early corticosteroid administration within the emergency department to help lessen length of stay. Properties of dexamethasone make it appear superior to prednisolone, but prospective randomized trials are necessary, as previous studies did not show significant improvements for decrease in length of stay or in admissions. As treatment protocols become more common, a prospective study that validates early use of oral corticosteroids and choice of oral steroid may help to both lessen the length of stay and decrease hospital admissions for asthma exacerbations. A limitation of this study was that type of oral steroid medication and other asthma medication use was left to the discretion of the treating physician, which may affect length of stay as well.
- Copyright © 2013 by the American Academy of Pediatrics