Adjunct Corticosteroids in Children Hospitalized With Community-Acquired Pneumonia
- 1 February 2011
- journal article
- research article
- Published by American Academy of Pediatrics (AAP) in PEDIATRICS
- Vol. 127 (2), e255-e263
- https://doi.org/10.1542/peds.2010-0983
Abstract
OBJECTIVE: To determine if systemic corticosteroid therapy is associated with improved outcomes for children hospitalized with community-acquired pneumonia (CAP). METHODS: In this multicenter, retrospective cohort study we used data from 36 children's hospitals for children aged 1 to 18 years with CAP. Main outcome measures were length of stay (LOS), readmission, and total hospitalization cost. The primary exposure was the use of adjunct systemic corticosteroids. Multivariable regression models and propensity scores were used to adjust for confounders. RESULTS: The 20 703 patients whose data were included had a median age of 4 years. Adjunct corticosteroid therapy was administered to 7234 patients (35%). The median LOS was 3 days, and 245 patients (1.2%) required readmission. Systemic corticosteroid therapy was associated with shorter LOS overall (adjusted hazard ratio [HR]: 1.24 [95% confidence interval (CI): 1.18–1.30]). Among children who received treatment with β-agonists, the LOS was shorter for children who had received corticosteroids compared with children who had not (adjusted HR: 1.36 [95% CI: 1.28–1.45]). Among children who did not receive β-agonists, the LOS was longer for those who received corticosteroids compared with those who did not (adjusted HR: 0.85 [95% CI: 0.75–0.96]). Corticosteroids were associated with readmission of patients who did not receive concomitant β-agonist therapy (adjusted odds ratio: 1.97 [95% CI: 1.09–3.57]). CONCLUSIONS: For children hospitalized with CAP, adjunct corticosteroids were associated with a shorter hospital LOS among patients who received concomitant β-agonist therapy. Among patients who did not receive this therapy, systemic corticosteroids were associated with a longer LOS and a greater odds of readmission. If β-agonist therapy is considered a proxy for wheezing, our findings suggest that among patients admitted to the hospital with a diagnosis of CAP, only those with acute wheezing benefit from adjunct systemic corticosteroid therapy.Keywords
This publication has 44 references indexed in Scilit:
- Intravenous Immunoglobulin in Children with Streptococcal Toxic Shock SyndromeClinical Infectious Diseases, 2009
- The Impact of Steroids Given with Macrolide Therapy on ExperimentalMycoplasma pneumoniaeRespiratory InfectionThe Journal of Infectious Diseases, 2008
- Acute Lower Respiratory Tract InfectionThe New England Journal of Medicine, 2008
- The role of corticosteroids in severe community-acquired pneumonia: a systematic reviewCritical Care, 2008
- Systemic cytokine profile in children with community‐acquired pneumoniaPediatric Pulmonology, 2007
- A review of the application of propensity score methods yielded increasing use, advantages in specific settings, but not substantially different estimates compared with conventional multivariable methodsJournal of Clinical Epidemiology, 2006
- Role of prednisolone treatment in severe Mycoplasma pneumoniae pneumonia in childrenPediatric Pulmonology, 2006
- Inflammation – A New Therapeutic Target in PneumoniaRespiration, 2005
- Hazard Ratio in Clinical TrialsAntimicrobial Agents and Chemotherapy, 2004
- The central role of the propensity score in observational studies for causal effectsBiometrika, 1983