Children given corticosteroids for asthma attacks soon after arriving at an emergency room have lower hospital admission rates and shorter treatment lengths.
In children with moderate to severe asthma, administering corticosteroids within 75 minutes of arrival at the emergency department (ED) decreases both hospital admission rates and length of treatment, according to the results of a study published online March 12, 2012, in Annals of Emergency Medicine
Over a 12-week study period, researchers reviewed the charts of 1539 children seen for asthma attacks in the ED at Montreal Children’s Hospital of McGill University. Of these, they selected 406 study participants, all of whom were between 2 and 17 years of age, had moderate to severe respiratory obstruction, and had been treated with at least 1 dose of albuterol in the ED.
Of the 406 patients in the study, 88% had moderate asthma and 12% had severe asthma. Systemic corticosteroids were administered to 205 participants within 75 minutes of their initial ED assessment. Of the remaining 201 patients, 133 received corticosteroids after the 75-minute cut-off, and 68 did not receive corticosteroids at all.
The researchers determined that early administration of the corticosteroids significantly decreased rates of admission and treatment length. For each additional 30-minute delay in corticosteroid administration, a patient’s odds of being admitted to the hospital increased 1.23% and their duration of treatment increased by 60 minutes.
The researchers note that corticosteroid administration was more likely to be delayed for patients determined to be a lower triage priority. Likewise, patients with more severe respiratory obstruction were more likely to have the corticosteroids administered within the 75-minute window.
The study authors acknowledge that these typical treatment biases may have distorted their data, but note that it would be unethical to run a study in which treatment with corticosteroids was completely randomized. They also note that the bias was partially addressed by excluding cases of mild asthma and adjusting for attack severity.
To read the study, click here
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