{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T23:14:18Z","timestamp":1790723658626,"version":"4.1.0"},"reference-count":27,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2024,3,8]],"date-time":"2024-03-08T00:00:00Z","timestamp":1709856000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007305","name":"Maternal and Child Health Bureau","doi-asserted-by":"publisher","award":["U1IMC45814"],"award-info":[{"award-number":["U1IMC45814"]}],"id":[{"id":"10.13039\/100007305","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Timely administration of systemic corticosteroids is a cornerstone of asthma exacerbation treatment, yet little is known regarding potential benefits of prehospital administration by emergency medical services (EMS) clinicians. We examined factors associated with prehospital corticosteroid administration with hospitalization and hospital length of stay (LOS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a retrospective study of EMS encounters for patients 2\u201350\u2009years of age with suspected asthma exacerbation from a national data set. We evaluated factors associated with systemic corticosteroid administration using generalized estimating equations. We performed propensity matching based on service level, age, encounter duration, vital signs, and treatments to evaluate the association of prehospital corticosteroid administration with hospitalization and LOS using weighted logistic regression. We evaluated the association of prehospital corticosteroid administration with admission using Bayesian models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 15,834 encounters, 4731 (29.9%) received prehospital systemic corticosteroids. Administration of corticosteroids was associated with older age; sex; urbanicity; advanced life support provider; vital sign instability; increasing doses of albuterol; and provision of ipratropium bromide, magnesium, epinephrine, and supplementary oxygen. Within the matched sample, prehospital corticosteroids were not associated with hospitalization (odds ratio [OR] 0.86, 95% confidence interval [CI] 0.73\u20131.01) or LOS (multiplier 0.76, 95% CI 0.56\u20131.05). Administration of corticosteroids was associated with lower odds of admission and shorter LOS in longer EMS encounters (&gt;34\u2009min), lower admission odds in patients with documented wheezing, and shorter LOS among patients treated with albuterol. In a Bayesian model with noninformative priors, the OR for admission among encounters given corticosteroids was 0.86 (95% credible interval 0.77\u20130.96).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Prehospital systemic corticosteroid administration was not associated with hospitalization or LOS in the overall cohort of asthma patients treated by EMS, though they had a lower probability of admission within Bayesian models. Improved outcomes were noted among subgroups of longer EMS encounters, documented wheezing, and receipt of albuterol.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.14890","type":"journal-article","created":{"date-parts":[[2024,3,8]],"date-time":"2024-03-08T10:29:52Z","timestamp":1709893792000},"page":"675-687","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The association of prehospital systemic corticosteroids with emergency department and in\u2010hospital outcomes for patients with asthma exacerbations"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1389-5726","authenticated-orcid":false,"given":"Sriram","family":"Ramgopal","sequence":"first","affiliation":[{"name":"Division of Emergency Medicine, Ann &amp; Robert H. Lurie Children's Hospital of Chicago Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishal V.","family":"Naik","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Ann &amp; Robert H. Lurie Children's Hospital of Chicago Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sho","family":"Komukai","sequence":"additional","affiliation":[{"name":"Division of Biomedical Statistics, Department of Integrated Medicine Osaka University Graduate School of Medicine  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8201-4267","authenticated-orcid":false,"given":"Sylvia","family":"Owusu\u2010Ansah","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine UPMC Children's Hospital of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Remle P.","family":"Crowe","sequence":"additional","affiliation":[{"name":"ESO  Austin Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masashi","family":"Okubo","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Pittsburgh School of Medicine  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Martin\u2010Gill","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Pittsburgh School of Medicine  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,3,8]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/10903127.2022.2079779"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/emp2.13026"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(99)70266-0"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.317.7164.971"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1067\/mem.2000.105659"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2003.11.016"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.Cd002178"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1155\/2004\/271362"},{"key":"e_1_2_9_10_1","unstructured":"National Heart Lung and Blood Institute Asthma Education and Prevention Program.Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma US Department of Health and Human Services. 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