Assistant Professor University of Colorado / Children's Hospital Colorado University of Colorado School of Medicine Aurora, Colorado, United States
Background: Many pediatric emergency departments (PED) clinicians use dexamethasone as the preferred corticosteroid for children with acute asthma exacerbations. However, reasons for one-dose (visit only) versus two-dose dexamethasone regimens are not known.
Objective: To examine dexamethasone prescribing practices and adherence with two-dose regimens in children with acute asthma exacerbations discharged from the PED.
Design/Methods: Prospective cohort study of children 2-18 years presenting to a tertiary-care PED and discharged after treatment for acute asthma exacerbations. Demographics, chronic asthma severity, illness symptoms, asthma treatments received, length of stay (LOS), and discharge prescription information were obtained. Phone follow-up occurred 7-10 days post-PED visit. Provider prescribing practices for dexamethasone (i.e. dosing and duration) and caregiver practices (i.e. receiving, filling, and administering dexamethasone prescriptions) were evaluated. Factors associated with prescription for two-dose dexamethasone regimen were comparted using chi-square or Fisher’s exact test for categorical variables, and comparison of continuous variables were made according to parametric distributions.
Results: There were 276 patients enrolled; 171 (62%) completed follow-up. Children were a median age of 7 years, 32% were African American, 49% were Hispanic, and 82% had public insurance. Patients were prescribed a two-dose dexamethasone regimen for 82% of visits. The median dose prescribed was 0.5 mg/kg (0.3,0.6) with a maximum dose of 0.8 mg/kg (Table 1). A two-dose dexamethasone regimen was associated with receipt of inhaled combined albuterol and ipratropium bromide (p<0.01), higher triage Pediatric Asthma Severity (PAS) score (p=0.02), and longer ED LOS (p<0.01). Chronic asthma severity or concurrent lower respiratory tract infection were not associated with a two-dose regimen (Table 2). Of patients who were prescribed a two-dose regimen, 93% of caregivers recalled receipt of the prescription. Of caregivers who recalled receipt of a two-dose regimen, 92% reported filling the prescription and of those, 97% reported giving the second dose. Conclusion(s): A two-dose dexamethasone regimen is most often prescribed for children discharged from PED with severe asthma exacerbations. Caregivers report adherence to a two-dose regimen when prescribed. Additional studies are needed to evaluate the impact of dexamethasone dosing and adherence on clinical outcomes to optimize use for pediatric asthma exacerbations.
Table 2. Demographics, asthma history, and clinical characteristics of study population with discharge dexamethasone prescription (two-dose regimen) vs. no dexamethasone prescription (one-dose regimen).
Authors/Institutions: Melisa Tanverdi, University of Colorado School of Medicine, Denver, Colorado, United States; Lorel Huber, University of Colorado School of Medicine, Denver, Colorado, United States; Jan Leonard, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States; Rakesh D. Mistry, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, Colorado, United States; Nidhya Navanandan, Children's Hospital Colorado, Denver, Colorado, United States
