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J Pediatr. 2015 Sep;167(3):639-44.e1. doi: 10.1016/j.jpeds.2015.06.038.

Comparative Effectiveness of Dexamethasone versus Prednisone in Children Hospitalized with Asthma.

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Division of Hospital Medicine, Department of Pediatrics, Children's National Medical Center and George Washington School of Medicine, Washington, DC. Electronic address:
Children's Hospital Association, Overland Park, KS.
Children's Medical Center and University of Texas Southwestern Medical Center, Dallas, TX.
Children's Mercy Hospitals and Clinics and University of Missouri-Kansas City School of Medicine, Kansas City, MO.
New York-Presbyterian Morgan Stanley Children's Hospital and Columbia University Medical Center, New York, NY.
Division of Pediatric Medicine, Department of Pediatrics and Institute for Health Policy, Management and Evaluation, University of Toronto; SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.
Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, CO.
Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.



To study the comparative effectiveness of dexamethasone vs prednisone/prednisolone in children hospitalized with asthma exacerbation not requiring intensive care.


This multicenter retrospective cohort study, using the Pediatric Health Information System, included children aged 4-17 years who were hospitalized with a principal diagnosis of asthma between January 1, 2007 and December 31, 2012. Children with chronic complex condition and/or initial intensive care unit (ICU) management were excluded. Propensity score matching was used to detect differences in length of stay (LOS), readmissions, ICU transfer, and cost between groups.


40,257 hospitalizations met inclusion criteria; 1166 (2.9%) received only dexamethasone. In the matched cohort (N = 1284 representing 34 hospitals), the LOS was significantly shorter in the dexamethasone group compared with the prednisone/prednisolone group. The proportion of subjects with a LOS of 3 days or more was 6.7% in the dexamethasone group and 12% in the prednisone/prednisolone group (P = .002). Differences in all-cause readmission at 7- and 30 days were not statistically significant. The dexamethasone group had lower costs of index admission ($2621 vs $2838; P < .001) and total episode of care (including readmissions) ($2624 vs $2856; P < .001) compared with the prednisone/prednisolone group. There were no clinical significant differences in ICU transfer or readmissions between groups.


Dexamethasone may be considered an alternative to prednisone/prednisolone for children hospitalized with asthma exacerbation not requiring admission to intensive care.

[Indexed for MEDLINE]

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