title: Early administration of systemic corticosteroids reduces hospital admission rates for children with moderate and severe asthma exacerbation.
abstract: OBJECTIVE
  The variable effectiveness of clinical asthma pathways to reduce hospital admissions may be explained in part by the timing of systemic corticosteroid administration. We examine the effect of early (within 60 minutes [SD 15 minutes] of triage) versus delayed (>75 minutes) administration of systemic corticosteroids on health outcomes.
  
  
  METHODS
  We conducted a prospective observational cohort of children aged 2 to 17 years presenting to the emergency department with moderate or severe asthma, defined as a Pediatric Respiratory Assessment Measure (PRAM) score of 5 to 12. The outcomes were hospital admission, relapse, and length of active treatment; they were analyzed with multivariate logistic and linear regressions adjusted for covariates and potential confounders.
  
  
  RESULTS
  Among the 406 eligible children, 88% had moderate asthma; 22%, severe asthma. The median age was 4 years (interquartile range 3 to 8 years); 64% were male patients. Fifty percent of patients received systemic corticosteroids early; in 33%, it was delayed; 17% of children failed to receive any. Overall, 36% of patients were admitted to the hospital. Compared with delayed administration, early administration reduced the odds of admission by 0.4 (95% confidence interval 0.2 to 0.7) and the length of active treatment by 0.7 hours (95% confidence interval -1.3 to -0.8 hours), with no significant effect on relapse. Delayed administration was positively associated with triage priority and negatively with PRAM score.
  
  
  CONCLUSIONS
  In this study of children with moderate or severe asthma, administration of systemic corticosteroids within 75 minutes of triage decreased hospital admission rate and length of active treatment, suggesting that early administration of systemic corticosteroids may allow for optimal effectiveness.
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada. sanjit.bhogal@gmail.com
authors.forename: Sanjit K
authors.initials: SK
authors.lastname: Bhogal
authors.forename: David
authors.initials: D
authors.lastname: McGillivray
authors.forename: Jean
authors.initials: J
authors.lastname: Bourbeau
authors.forename: Andrea
authors.initials: A
authors.lastname: Benedetti
authors.forename: Susan
authors.initials: S
authors.lastname: Bartlett
authors.forename: Francine M
authors.initials: FM
authors.lastname: Ducharme
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000627:therapeutic use; D000420:Albuterol / Q000008:administration & dosage / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D019091:Critical Pathways; D004359:Drug Therapy, Combination; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011239:Prednisolone / Q000008:administration & dosage* / Q000627:therapeutic use; D011241:Prednisone / Q000008:administration & dosage* / Q000627:therapeutic use; D011446:Prospective Studies; D012720:Severity of Illness Index; D013224:Status Asthmaticus / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014218:Triage
chemical_list: D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents; D011239:Prednisolone; D000420:Albuterol; D011241:Prednisone