Early Administration of Steroids in the Ambulance Setting: An Observational Design Trial (EASI-AS-ODT)

Authors

Jennifer N Fishe
Gerard Garvan
Andrew Bertrand
Shannon Burcham
Phyllis Hendry
Manish Shah
Kathryn Kothari
David W Ashby
Daniel Ostermeyer
Lauren Riney
Olga Semenova
Benjamin Abo
Benjamin Abes
Nichole Shimko
Emily Myers
Marshall Frank
Tim Turner
Mac Kemp
Kim Landry
Greg Roland
Kathryn V Blake

Publication Date

1-1-2024

Journal

Academic Emergency Medicine

DOI

10.1111/acem.14813

PMID

37786991

PMCID

PMC10842452

PubMedCentral® Posted Date

1-1-2025

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Child, Humans, Adolescent, Ambulances, Asthma, Adrenal Cortex Hormones, Steroids, Emergency Medical Services, Emergency Service, Hospital, Asthma, Emergency Medical Services, Pediatric Asthma, Pediatric Emergency Medicine, Systemic Corticosteroids

Abstract

BACKGROUND: In the emergency department (ED), prompt administration of systemic corticosteroids for pediatric asthma exacerbations decreases hospital admission rates. However, there is sparse evidence for whether earlier administration of systemic corticosteroids by emergency medical services (EMS) clinicians, prior to ED arrival, further improves pediatric asthma outcomes.

METHODS: Early Administration of Steroids in the Ambulance Setting: An Observational Design Trial is a multicenter, observational, nonrandomized stepped-wedge design study with seven participating EMS agencies who adopted an oral systemic corticosteroid (OCS) into their protocols for pediatric asthma treatment. Using univariate analyses and multivariable mixed-effects models, we compared hospital admission rates for pediatric asthma patients ages 2-18 years before and after the introduction of a prehospital OCS and for those who did and did not receive a systemic corticosteroid from EMS.

RESULTS: A total of 834 patients were included, 21% of whom received a systemic corticosteroid from EMS. EMS administration of systemic corticosteroids increased after the introduction of an OCS from 14.7% to 28.1% (p < 0.001). However, there was no significant difference between hospital admission rates and ED length of stay before and after the introduction of OCS or between patients who did and did not receive a systemic corticosteroid from EMS. Mixed-effects models revealed that age 14-18 years (coefficient -0.83, p = 0.002), EMS administration of magnesium (coefficient 1.22, p = 0.04), and initial EMS respiratory severity score (coefficient 0.40, p < 0.001) were significantly associated with hospital admission.

CONCLUSIONS: In this multicenter study, the addition of an OCS into EMS agency protocols for pediatric asthma exacerbations significantly increased systemic corticosteroid administration but did not significantly decrease hospital admission rates. As overall EMS systemic corticosteroid administration rates were low, further work is required to understand optimal implementation of EMS protocol changes to better assess potential benefits to patients.