# Managing Pediatric Asthma Exacerbations: The Role of Timely Systemic Corticosteroid Administration in Emergency Care Settings—A Multicentric Retrospective Study

## TL;DR

This study found that most children with severe asthma attacks in emergency rooms did not receive timely steroid treatment, which was linked to longer hospital stays and more oxygen use.

## Contribution

The study provides new evidence on the low rate of timely corticosteroid administration in pediatric asthma exacerbations and its clinical impact.

## Key findings

- Only 28 out of 205 children received corticosteroids within 1 hour of ED arrival.
- Delayed corticosteroid administration correlated with longer oxygen therapy and hospital stays.
- No patient characteristics predicted timely corticosteroid administration.

## Abstract

Background: Asthma is the most prevalent chronic respiratory condition in children. An asthma exacerbation (AE) is a frequent reason for emergency department (ED) visits. An important step in the management of a moderate to severe AE is the administration of systemic corticosteroids (SCS) within 1 h after ED presentation. This study aimed to determine the timing of SCS administration and correlate this with the length of stay and oxygen therapy duration and to explore factors predicting timely administration. Methods: This study used a retrospective multicenter observational design based on electronic medical records review. Children aged < 18 years, presenting to the ED with a moderate to severe AE were included. Results: 205 patients were included. Only 28 patients received SCS within 60 min after ED arrival. The median time to SCS administration was 169 min (Q1 92–Q3 380). A correlation was found between timing and oxygen treatment duration (r = 0.363, p < 0.001) and length of stay (r = 0.368, p < 0.001). No patient characteristics predicted timely SCS administration. Conclusions: Three in four children who presented with a moderate to severe AE at the ED did not receive SCS within the first hour. A prolonged timing of SCS administration correlated with a prolonged length of stay and extended need for oxygen support.