Early steroid administration for pediatric asthma in the emergency department: a way to move outcomes?
Minhas, Amar Singh
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Asthma is a chronic disease of the lungs and respiratory passages. Hallmarks of asthma exacerbation, commonly referred to as an “asthma attack,” are bronchoconstriction, inflammation, and airway remodeling. Millions of people worldwide have asthma, with both children and adults affected by the disease. Asthma prevalence in the United States has been increasing on a yearly basis, and thus asthma is a serious health threat to people of all ages. Asthma can be controlled with short term bronchodilatory drugs and inhaled corticosteroids for long-term inflammation management. Pediatric asthma is particularly taxing, however, as it can cause numerous absences from school, frequent hospitalizations, and can be difficult for children to manage without close supervision. Many of these pediatric patients present in emergency departments, and are given oral or IV steroids to treat the asthma exacerbation. We specifically want to assess the effect of early administration of these steroids on the patient outcomes of admission rate and length of stay. We hypothesize that patients given steroids sooner rather than later are less likely to be admitted to inpatient status and will have a shorter stay in the emergency department. To test our hypotheses, we conducted a retrospective study in which we gathered pediatric patient data from August, 2011, to April, 2012. We included patients that presented with asthma exacerbation and recorded a number of metrics and variables for each patient, including time of steroid administration, admission status, and total length of stay in the emergency department. Steroid administration time was separated into two categories: administration pre or post-30 minutes of triage, and administration pre or post-60 minutes of triage. This data was logged, reviewed, and finally analyzed for statistical significance. Results of the study showed that there is no statistically significant association between time of steroid administration on admission rates. To assess the relationship of steroid administration time and length of stay in the emergency department, patients with the same admission status were compared against one another in order to eliminate potential confounding (i.e. length of stay for admitted patients who received steroids within 30 minutes was compared to that of admitted patients receiving steroids post-30 minutes, and so on). Overall, those patients receiving steroids tended to have a shorter mean length of stay in the emergency department. This finding was statistically significant for only one subset of the patient sample, however: discharged patients who received their steroids pre-60 minutes as opposed to post-60 minutes. While the data that we analyzed did not depict many statistically significant associations, it did reveal trends in outcomes that are associated with timing of steroid administration. With further study and an expanded sample size, these associations may prove to be of significance. From a clinical perspective, such findings could impact emergency asthma care, with early steroid administration becoming more of a priority in treatment protocols.
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