title: Adjunct corticosteroids in children hospitalized with community-acquired pneumonia.
abstract: OBJECTIVE
  To determine if systemic corticosteroid therapy is associated with improved outcomes for children hospitalized with community-acquired pneumonia (CAP).
  
  
  METHODS
  In this multicenter, retrospective cohort study we used data from 36 children's hospitals for children aged 1 to 18 years with CAP. Main outcome measures were length of stay (LOS), readmission, and total hospitalization cost. The primary exposure was the use of adjunct systemic corticosteroids. Multivariable regression models and propensity scores were used to adjust for confounders.
  
  
  RESULTS
  The 20 703 patients whose data were included had a median age of 4 years. Adjunct corticosteroid therapy was administered to 7234 patients (35%). The median LOS was 3 days, and 245 patients (1.2%) required readmission. Systemic corticosteroid therapy was associated with shorter LOS overall (adjusted hazard ratio [HR]: 1.24 [95% confidence interval (CI): 1.18-1.30]). Among children who received treatment with β-agonists, the LOS was shorter for children who had received corticosteroids compared with children who had not (adjusted HR: 1.36 [95% CI: 1.28-1.45]). Among children who did not receive β-agonists, the LOS was longer for those who received corticosteroids compared with those who did not (adjusted HR: 0.85 [95% CI: 0.75-0.96]). Corticosteroids were associated with readmission of patients who did not receive concomitant β-agonist therapy (adjusted odds ratio: 1.97 [95% CI: 1.09-3.57]).
  
  
  CONCLUSIONS
  For children hospitalized with CAP, adjunct corticosteroids were associated with a shorter hospital LOS among patients who received concomitant β-agonist therapy. Among patients who did not receive this therapy, systemic corticosteroids were associated with a longer LOS and a greater odds of readmission. If β-agonist therapy is considered a proxy for wheezing, our findings suggest that among patients admitted to the hospital with a diagnosis of CAP, only those with acute wheezing benefit from adjunct systemic corticosteroid therapy.
authors.affiliation: Division of Infectious Diseases, Children's Hospital of Philadelphia, Room 1526, North Campus, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
authors.forename: Anna K
authors.initials: AK
authors.lastname: Weiss
authors.forename: Matthew
authors.initials: M
authors.lastname: Hall
authors.forename: Grace E
authors.initials: GE
authors.lastname: Lee
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Kronman
authors.forename: Seth
authors.initials: S
authors.lastname: Sheffler-Collins
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000639:trends; D008297:Male; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000453:epidemiology*; D011024:Pneumonia, Viral / Q000188:drug therapy / Q000453:epidemiology; D012189:Retrospective Studies
chemical_list: D000305:Adrenal Cortex Hormones