ArticlePediatric emergency care2013
Emergency department crowding and younger age are associated with delayed corticosteroid administration to children with acute asthma.
Article in Pediatric emergency care, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
13 citing papers in PubMed.
- Adherence to Pediatric Asthma Guidelines in Children with Asthma Exacerbation at the Emergency Department.Open access emergency medicine : OAEM · 2026Article
- Characteristics and Admission Preferences of Pediatric Emergency Patients and Their Waiting Time Prediction Using Electronic Medical Record Data: Retrospective Comparative Analysis.Journal of medical Internet research · 2023Article
- Initial emergency department vital signs may predict PICU admission in pediatric patients presenting with asthma exacerbation.The Journal of asthma : official journal of the Association for the Care of Asthma · 2023Observational
- Factors Associated with Unscheduled Emergency Department Revisits in Children with Acute Lower Respiratory Tract Diseases.Open access emergency medicine : OAEM · 2022Article
- Evaluating the transitions in care for children presenting with acute asthma to emergency departments: a retrospective cohort study.BMC emergency medicine · 2021Article
- Emergency department crowding negatively influences outcomes for children presenting with asthma: a population-based retrospective cohort study.Pediatric research · 2021Article
- Are reductions in emergency department length of stay associated with improvements in quality of care? A difference-in-differences analysis.BMJ quality & safety · 2016Article
- Improving timeliness for acute asthma care for paediatric ED patients using a nurse driven intervention: an interrupted time series analysis.BMJ quality improvement reports · 2016Article
- Clinical pathway improves pediatrics asthma management in the emergency department and reduces admissions.The Journal of asthma : official journal of the Association for the Care of Asthma · 2015Article
- A Report of an Asthma Pathway Leading to Improved Resource Use.The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAGArticle
- A Quality Improvement Initiative to Improve the Administration of Systemic Corticosteroids in the Pediatric Emergency Department.Pediatric quality & safetyArticle
- Reducing Time from Pediatric Emergency Department Arrival to Dexamethasone Administration in Wheezing Patients.Pediatric quality & safetyArticle
- Adjacent Primary Care May Reduce Less Urgent Pediatric Emergency Department Visits.Journal of primary care & community healthArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
Abstract
objectiveThis study aimed to identify factors associated with delayed or omission of indicated steroids for children seen in the emergency department (ED) for moderate-to-severe asthma exacerbation.
methodsThis was a retrospective study of pediatric (age ≤ 21 years) patients treated in a general academic ED from January 2006 to September 2011 with a primary diagnosis of asthma (International Classification of Diseases, Ninth Revision code 493.xx) and moderate-to-severe exacerbations. A moderate-to-severe exacerbation was defined as requiring 2 or more (or continuous) bronchodilators. We determined the proportion of visits in which steroids were inappropriately omitted or delayed (>1 hour from arrival). Multivariable logistic regression models were used to identify patient, physician, and system factors associated with delayed or omitted steroids.
resultsOf 1333 pediatric asthma ED visits, 817 were for moderate-to-severe exacerbation; 645 (79%) received steroids. Patients younger than 6 years (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.19-4.24), requiring more bronchodilators (OR, 2.82; 95% CI, 2.10-3.79), initially hypoxic (OR, 2.78; 95% CI, 1.33-5.83), or tachypneic (OR, 1.52; 95% CI, 1.05-2.20) were more likely to receive steroids. Median time to steroid administration was 108 minutes (interquartile range, 65-164 minutes). Steroid administration was delayed in 502 visits (78%). Patients with hypoxia (OR, 1.91; 95% CI, 1.11-3.27) or tachypnea (OR, 1.82; 95% CI, 1.17-2.84) were more likely to receive steroids 1 hour or less of arrival, whereas children younger than 2 years (OR, 0.16; 95% CI, 0.07-0.35) and those arriving during periods of higher ED volume (OR, 0.79; 95% CI, 0.67-0.94) were less likely to receive timely steroids.
conclusionsIn this ED, steroids were underprescribed and frequently delayed for pediatric ED patients with moderate-to-severe asthma exacerbation. Greater ED volume and younger age are associated with delays. Interventions are needed to expedite steroid administration, improving adherence to National Institutes of Health asthma guidelines.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.