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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.

Author information

1
Division of Hospital Medicine, Department of Pediatrics, Children's National Medical Center and George Washington School of Medicine, Washington, DC. Electronic address: kparikh@childrensnational.org.
2
Children's Hospital Association, Overland Park, KS.
3
Children's Medical Center and University of Texas Southwestern Medical Center, Dallas, TX.
4
Children's Mercy Hospitals and Clinics and University of Missouri-Kansas City School of Medicine, Kansas City, MO.
5
New York-Presbyterian Morgan Stanley Children's Hospital and Columbia University Medical Center, New York, NY.
6
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.
7
Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, CO.
8
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.

Abstract

OBJECTIVES:

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

STUDY DESIGN:

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.

RESULTS:

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.

CONCLUSIONS:

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

PMID:
26319919
DOI:
10.1016/j.jpeds.2015.06.038
[Indexed for MEDLINE]

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