The ED's clinical pathway recommended systemic prednisone or prednisolone (1mg/kg; maximum, 50 mg) administered within 60 minutes of triage.

Overall, 36% of patients were admitted or had prolonged ED length of stay (>6 hours), and 6% relapsed within 72 hours of ED discharge. Patients who received corticosteroids early were less likely than those who received corticosteroids late or not at all to be admitted or have prolonged ED stay (odds ratio, 0.07).

For every 30-minute delay in corticosteroid administration, active ED treatment time increased by 60 minutes and odds of admission increased by 1.23. Delays were less likely in patients with severe asthma exacerbations (Pediatric Respiratory Assessment Measure score 8; OR, 0.17).

Compared to patients who received delayed treatment, those who did not receive corticosteroids had lower admission rates and shorter active ED treatment time (OR, 0.1 and –2.2, respectively).

Factors associated with not receiving corticosteroids included preschool patient age (OR, 2.50), lower triage priority (OR, 11.26), physician graduation more than 20 years prior (OR, 3.32), and nonpediatric emergency medicine specialty or general practitioner (OR, 3.33 and 4.82, respectively, compared to pediatric emergency specialty).

Comment: Although children who did not receive corticosteroids had less severe asthma, steroids would still be indicated for them. The finding that provider characteristics were associated with no corticosteroid administration indicates a need for education and implementation of evidence-based treatment pathways.

As previously shown, triage administration of steroids for asthma is feasible and effective for preventing unnecessary admissions

(JW Emerg Med Apr 13 2012).— Katherine Bakes, MD Published in Journal Watch Emergency Medicine July 20, 2012