title: Glucocorticoids and Hospital Length of Stay for Children with Anaphylaxis: A Retrospective Study.
abstract: OBJECTIVE
  To evaluate whether glucocorticoid administration is associated with improved outcomes in children with anaphylaxis.
  
  
  METHODS
  We included children from the Pediatric Health Information System database who were diagnosed with anaphylaxis at 35 US children's hospitals between 2009 and 2013. Patients were stratified by disposition from the emergency department (ED), either hospitalized or discharged. We evaluated the association between glucocorticoid administration and prolonged length of stay (LOS), defined as hospital stay ≥ 2 days, and subsequent epinephrine administration among hospitalized children. Among discharged children, we assessed the association between glucocorticoid administration and ED revisits within 3 days. Analyses were adjusted for illness severity using ordering of laboratory tests, medications, oxygen, intravenous fluids, and admission to the intensive care unit.
  
  
  RESULTS
  Among 5203 children hospitalized with anaphylaxis, 424 (8.2%) had prolonged LOS. Glucocorticoid administration was inversely associated with prolonged LOS (aOR, 0.61; 95% CI, 0.41-0.93) and with subsequent epinephrine use (aOR, 0.63; 95% CI, 0.43-0.84) among hospitalized children. Glucocorticoid administration was not associated with the odds of a 3-day revisit (aOR, 1.01; 95% CI, 0.50-2.05) among discharged patients.
  
  
  CONCLUSIONS
  The use of glucocorticoids was inversely associated with prolonged LOS among children hospitalized with anaphylaxis, but was not associated with 3-day ED revisits among discharged children. These findings support the use of glucocorticoids in children hospitalized with anaphylaxis.
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital, Boston, MA. Electronic address: kenneth.michelson@childrens.harvard.edu.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Michelson
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Monuteaux
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.
authors.forename: Mark I
authors.initials: MI
authors.lastname: Neuman
mesh_terms: D000707:Anaphylaxis / Q000188:drug therapy* / Q000453:epidemiology; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D004363:Drug Utilization / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
chemical_list: D001993:Bronchodilator Agents; D005938:Glucocorticoids; D004837:Epinephrine