Article: Erik R. Hoefgen, Bin Huang, Christine L. Schuler, Carolyn M. Kercsmar, Eileen Murtagh-Kurowski, Melissa Forton, Katherine A. Auger; Dexamethasone Versus Prednisone in Children Hospitalized With Asthma Exacerbation. Hosp Pediatr March 2022; 12 (3): 325–335. https://doi.org/10.1542/hpeds.2021-006276
Fellow: Matthew Authement, MD; Mayo Clinic Children’s Center
Summary: The authors conducted a single center, retrospective cohort study that included 1161 patients, 4 – 17 years of age, admitted for asthma exacerbation who received both beta agonist and steroid therapy. The primary analysis cohort compared two groups based on first corticosteroid treatment dose (dexamethasone [44%] or prednisone [56%]). They found no significant difference in outcomes of asthma specific 30-day reutilizations (adjusted Odds Ratio (aOR) 1.61 (95% CI, 0.80–3.31)), PICU transfers (aOR 1.21 (95% CI 0.44–3.23)), or length of stay (aOR 1.03 (95% CI, 0.98–1.08)). This non-significant difference remained true on secondary analysis which looked at a single corticosteroid medication for the entirety of the treatment.
Key Strengths: Non-administrative data was used which allowed for propensity weighting. Propensity weighting allowed the authors to minimize potential confounding due to differences in severity at presentation as well as chronic asthma severity.
Limitations/Flaws: This is a single center, retrospective cohort study which may not be generalizable to other centers. In addition, they did not meet planned enrollment goals of 800 patients per treatment groups which may lead to missed small differences in each group. They only captured reutilization at their institution, which may miss re-utilization at other health systems.
Takeaway Message: In this cohort of patients, patients treated with dexamethasone and prednisone had similar rates of 30 day reutilizations, PICU transfers, and length of stay.
Practice Impact: When managing a patient admitted for asthma exacerbation/status asthmaticus, we have more evidence that dexamethasone can be safely used instead of prednisone without an increase in 30 day reutilizations, PICU transfers, or length of stay.
Fellow: Matthew Authement, MD; Mayo Clinic Children’s Center
Summary: The authors conducted a single center, retrospective cohort study that included 1161 patients, 4 – 17 years of age, admitted for asthma exacerbation who received both beta agonist and steroid therapy. The primary analysis cohort compared two groups based on first corticosteroid treatment dose (dexamethasone [44%] or prednisone [56%]). They found no significant difference in outcomes of asthma specific 30-day reutilizations (adjusted Odds Ratio (aOR) 1.61 (95% CI, 0.80–3.31)), PICU transfers (aOR 1.21 (95% CI 0.44–3.23)), or length of stay (aOR 1.03 (95% CI, 0.98–1.08)). This non-significant difference remained true on secondary analysis which looked at a single corticosteroid medication for the entirety of the treatment.
Key Strengths: Non-administrative data was used which allowed for propensity weighting. Propensity weighting allowed the authors to minimize potential confounding due to differences in severity at presentation as well as chronic asthma severity.
Limitations/Flaws: This is a single center, retrospective cohort study which may not be generalizable to other centers. In addition, they did not meet planned enrollment goals of 800 patients per treatment groups which may lead to missed small differences in each group. They only captured reutilization at their institution, which may miss re-utilization at other health systems.
Takeaway Message: In this cohort of patients, patients treated with dexamethasone and prednisone had similar rates of 30 day reutilizations, PICU transfers, and length of stay.
Practice Impact: When managing a patient admitted for asthma exacerbation/status asthmaticus, we have more evidence that dexamethasone can be safely used instead of prednisone without an increase in 30 day reutilizations, PICU transfers, or length of stay.