EMS Administration of Systemic Corticosteroids to Pediatric Asthma Patients: An Analysis by Severity and Transport Interval

Abstract

Introduction: Pediatric asthma exacerbations are a common cause of emergency medical services (EMS) encounters. Bronchodilators and systemic corticosteroids are mainstays of asthma exacerbation therapy, yet data on the efficacy of EMS administration of systemic corticosteroids are mixed. This study's objective was to assess the association between EMS administration of systemic corticosteroids to pediatric asthma patients on hospital admission rates based on asthma exacerbation severity and EMS transport intervals.

Methods: This is a sub-analysis of the Early Administration of Steroids in the Ambulance Setting: An Observational Design Trial (EASI AS ODT). EASI AS ODT is a non-randomized, stepped wedge, observational study examining outcomes one year before and one year after seven EMS agencies incorporated an oral systemic corticosteroid option into their protocols for the treatment of pediatric asthma exacerbations. We included EMS encounters for patients ages 2-18 years confirmed by manual chart review to have asthma exacerbations. We compared hospital admission rates across asthma exacerbation severities and EMS transport intervals using univariate analyses. We geocoded patients and created maps to visualize the general trends of patient characteristics.

Results: A total of 841 pediatric asthma patients met inclusion criteria. While most patients were administered inhaled bronchodilators by EMS (82.3%), only 21% received systemic corticosteroids, and only 19% received both inhaled bronchodilators and systemic corticosteroids. Overall, there was no significant difference in hospitalization rates between patients who did and did not receive systemic corticosteroids from EMS (33% vs. 32%, p = 0.78). However, although not statistically significant, for patients who received systemic corticosteroids from EMS, there was an 11% decrease in hospitalizations for mild exacerbation patients and a 16% decrease in hospitalizations for patients with EMS transport intervals greater than 40 min.

Conclusion: In this study, systemic corticosteroids were not associated with a decrease in hospitalizations of pediatric patients with asthma overall. However, while limited by small sample size and lack of statistical significance, our results suggest there may be a benefit in certain subgroups, particularly patients with mild exacerbations and those with transport intervals longer than 40 min. Given the heterogeneity of EMS agencies, EMS agencies should consider local operational and pediatric patient characteristics when developing standard operating protocols for pediatric asthma.

Figure 1.. Admission Rates by Severity for Patients Who Did and Did Not Receive a Systemic Corticosteroid from EMS

Admission rate difference with 95% confidence intervals (CIs) for patients receiving steroids versus those not receiving steroids: Mild −11.0%, 95% CI (−24.4%, 2.5%); Moderate 5.7%, 95% CI (−6.7%, 18.2%); Severe −1.6%, 95% CI (−21.3%, 18%)

Figure 2.. Admission Rates by EMS Transport Interval for Patients Who Did and Did Not Receive a Systemic Corticosteroid from EMS

Admission rate difference with 95% confidence intervals (CIs) for patients receiving steroids versus those not receiving steroids: 0-10 minutes 0.1%, 95% CI (−15.2%, 15.4%); 11-15 minutes −0.2%, 95% CI (−17.2%, 16.9%); 16-25 minutes 9.2%, 95% CI (−5.8%, 24.2%); 26-40 minutes −3.0%, 95% CI (−24.9%, 18.9%); > 40 minutes −16.7%, 95% CI (−84.1%, 50.8%)