A retrospective multi-center chart review study on the timely administration of systemic corticosteroids in children with moderate-to-severe asthma exacerbations

Introduction: Asthma exacerbations (AE) are one of the most common reasons for an Emergency Department (ED) visit in children. One of the most important steps, described in GINA guidelines, in the treatment of moderate-to-severe AE is a timely administration of systemic corticosteroids (SCS) within the first hour after initial presentation. Aims: This study, as part of a quality improvement project, aimed to investigate and compare the timing of SCS administration, in children with moderate-to-severe AE to the standard of 60 min after ED admission and to correlate the timing of SCS administration with the length of stay and need for oxygen therapy. Methods: This retrospective multi-center electronic medical records (EMR) study included children age <18 years, presenting at ED with a moderate-to-severe AE from Jan 2019 until Dec 2020 and was conducted at 7 EDs of hospitals of the Antwerp Pediatric Asthma Network. Results: The EMRs of 205 patients admitted to the ED with an AE were included. In total, 13.7% of patients received SCS within 60 minutes after ED arrival. The median time to SCS administration was 169 minutes (Q1 92-Q3 380). A weak correlation was found between the time to SCS administration and the duration of oxygen therapy (in days) (r=0.2, p<0.004). Lastly, a moderate correlation was found between the time of SCS administration and length of stay (r=0.406, p<0.001). Conclusion: In this study, approximately 3 in 4 children did not receive SCS within the recommended time frame. A prolonged timing of SCS administration was correlated with a prolonged length of stay and an extended need for oxygen support.