title: Comparative Effectiveness of Dexamethasone versus Prednisone in Children Hospitalized with Asthma.
abstract: OBJECTIVE
  To study the comparative effectiveness of dexamethasone vs prednisone/prednisolone in children hospitalized with asthma exacerbation not requiring intensive care.
  
  
  METHODS
  This multicenter retrospective cohort study, using the Pediatric Health Information System, included children aged 4-17 years who were hospitalized with a principal diagnosis of asthma between January 1, 2007 and December 31, 2012. Children with chronic complex condition and/or initial intensive care unit (ICU) management were excluded. Propensity score matching was used to detect differences in length of stay (LOS), readmissions, ICU transfer, and cost between groups.
  
  
  RESULTS
  40,257 hospitalizations met inclusion criteria; 1166 (2.9%) received only dexamethasone. In the matched cohort (N = 1284 representing 34 hospitals), the LOS was significantly shorter in the dexamethasone group compared with the prednisone/prednisolone group. The proportion of subjects with a LOS of 3 days or more was 6.7% in the dexamethasone group and 12% in the prednisone/prednisolone group (P = .002). Differences in all-cause readmission at 7- and 30 days were not statistically significant. The dexamethasone group had lower costs of index admission ($2621 vs $2838; P < .001) and total episode of care (including readmissions) ($2624 vs $2856; P < .001) compared with the prednisone/prednisolone group. There were no clinical significant differences in ICU transfer or readmissions between groups.
  
  
  CONCLUSIONS
  Dexamethasone may be considered an alternative to prednisone/prednisolone for children hospitalized with asthma exacerbation not requiring admission to intensive care.
authors: Division of Hospital Medicine, Department of Pediatrics, Children's National Medical Center and George Washington School of Medicine, Washington, DC. Electronic address: kparikh@childrensnational.org.
authors: Kavita
authors: K
authors: Parikh
authors: Children's Hospital Association, Overland Park, KS.
authors: Matt
authors: M
authors: Hall
authors: Children's Medical Center and University of Texas Southwestern Medical Center, Dallas, TX.
authors: Vineeta
authors: V
authors: Mittal
authors: Children's Mercy Hospitals and Clinics and University of Missouri-Kansas City School of Medicine, Kansas City, MO.
authors: Amanda
authors: A
authors: Montalbano
authors: New York-Presbyterian Morgan Stanley Children's Hospital and Columbia University Medical Center, New York, NY.
authors: Jessica
authors: J
authors: Gold
authors: Division of Pediatric Medicine, Department of Pediatrics and Institute for Health Policy, Management and Evaluation, University of Toronto; SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.
authors: Sanjay
authors: S
authors: Mahant
authors: Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, CO.
authors: Karen M
authors: KM
authors: Wilson
authors: Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
authors: Samir S
authors: SS
authors: Shah
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000188:drug therapy* / Q000191:economics; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003907:Dexamethasone / Q000627:therapeutic use*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D011241:Prednisone / Q000627:therapeutic use*; D057216:Propensity Score; D012189:Retrospective Studies; D014481:United States
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone; D011241:Prednisone