Assistant Professor University of Colorado Children's Hospital Colorado Denver, Colorado, United States
Background: Corticosteroids have potential for benefit in the treatment of community-acquired pneumonia (CAP) through mitigation of the associated inflammatory response. However, the impact of adjunct systemic corticosteroid therapy on clinical outcomes in children treated for CAP in the emergency department (ED) is unknown.
Objective: To determine the association between corticosteroid therapy and clinical outcomes in children treated for CAP in the ED with and without asthma.
Design/Methods: Secondary analysis from a prospective cohort study of previously healthy children age 3 months to 18 years with a chest radiograph (CXR) for suspected CAP in the ED between 2013-2017, excluding children with recent (14-day) corticosteroid use. The primary exposure was receipt of corticosteroids during the ED visit. Outcome measures were persistence of cough and wheeze 7-days post-ED discharge and admission. Multivariable logistic regression was used to evaluate the association between corticosteroid therapy and outcomes stratified by asthma status.
Results: Of 898 children, 18% received corticosteroids, 27% had history of wheeze or asthma, and 26% presented with wheeze. Of the 654 children with no history of asthma,10% received corticosteroids, of which 88% presented with wheeze. Of 239 children with a history of asthma, 39% received corticosteroids, of which 84% presented with wheeze. In the overall population, children who received corticosteroids were male (62%), Black (45%), and had history of wheeze or asthma, prior pneumonia, presence of wheeze and more severe illness at presentation (Table 1). Receipt of adjunct corticosteroid treatment was not associated with persistent symptoms post-ED discharge (aOR 1.30; 95% CI 0.87-1.95). However, among children with asthma, children who received corticosteroids had 2.20 (95% CI 1.11-4.34) odds of having persistent symptoms on follow-up compared with children who did not receive corticosteroids when adjusting for severity of illness at ED presentation (Table 2). Disposition was not associated with corticosteroid treatment in the adjusted model, even when stratified by asthma status. Conclusion(s): Adjunct corticosteroid therapy was not associated with improved outcomes among children diagnosed with CAP and was associated with worse outcomes in children with an underlying diagnosis of asthma. Our findings suggest a lack of benefit of adjunct systemic corticosteroid therapy for children with CAP.
Table 1. Characteristics of study population by receipt of systemic corticosteroids.
Table 2. Association between receipt of systemic corticosteroids and outcomes stratified by history of asthma.
Authors/Institutions: Nidhya Navanandan, Children's Hospital Colorado, Aurora, Colorado, United States; Todd Florin, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, United States; Jan Leonard, University of Colorado Denver School of Medicine, Aurora, Colorado, United States; Sriram Ramgopal, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, United States; Jillian Cotter, Children's Hospital Colorado, Aurora, Colorado, United States; Lilliam Ambroggio, University of Colorado, Children's Hospital Colorado, Aurora, Colorado, United States