Robert E Newmyer Ann & Robert H. Lurie Children's Hospital of Chicago Chicago, Illinois, United States
Introduction: Studies show that earlier steroid administration to pediatric patients with status asthmaticus by emergency medical services (EMS) prior to hospital arrival decreases hospital length of stay and rate of admission. However, steroids are administered at low rates by EMS. To our knowledge, there are no data regarding steroid administration to these patients during interfacility transport. Our aim is to describe the frequency of steroid administration prior to transport to our center and during transport, explore the variation in steroid dose administered, and examine if variable dosing is connected to different clinical outcomes.
Methods: We reviewed 202 charts of pediatric patients with status asthmaticus who were transported from a referring hospital to our center between September 2020 and January 2023. Our center’s standard initial dose of steroids for pediatric status asthmaticus is either 2 mg/kg of methylprednisolone or prednisone (maximum dose of 60 mg) or 0.6 mg/kg of dexamethasone (maximum dose of 16 mg). Data collected included steroid given, dose administered, if they were transferred to the PICU, if steroids were administered at the referring hospital or by our transport team, and each patient’s hospital length of stay (LOS).
Results: 97.8% of patients received steroids prior to transport. 1.1% received steroids from the transport team. 3.4% received steroids from our center upon arrival. 58% of patients received an initial dose of steroids that was equal to our center’s standard dose. 62% of these patients were admitted to the PICU, and they had an average hospital LOS of 2.70 days. 27.5% of patients received an initial dose of steroids that was less than our center’s standard dose. 59% of these patients were transferred to the PICU, and they had an average hospital LOS of 2.63 days. 13.5% of patients received an initial dose of steroids that was greater than our center’s standard dose. 71% of these patients were admitted to the PICU, and they had an average hospital LOS of 3.4 days.
Conclusions: There is variability of administered steroids given at referring hospitals prior to transport with our specialized team. Further analysis could more closely examine the relationship between steroid dose and clinical outcomes and evaluate for similar findings at other centers.
