Rates of Stress Ulcer Prophylaxis Deprescribing in Children Receiving Usual versus High-Dose Corticosteroids in the Pediatric Intensive Care Unit with Status Asthmaticus

Abstract

Purpose: To compare deprescribing rates of stress ulcer prophylaxis (SUP) between children receiving “usual-dose” (<4 mg/kg/day methylprednisolone equivalents) versus “high-dose” (≥4 mg/kg/day methylprednisolone equivalents) corticosteroids for status asthmaticus in the pediatric intensive care unit (PICU). Methods: This retrospective, cohort study included children <18 years of age receiving corticosteroids for status asthmaticus and SUP from 1/1/2017 to 6/31/2022. The primary objective was to compare the number of children that were deprescribed SUP following transition from the PICU to the floor and at hospital discharge between groups. Secondary objectives included a comparison of SUP-associated adverse events (ADEs) (pneumonia, Clostridium difficile colitis, thrombocytopenia, necrotizing enterocolitis) between groups. Comparisons were performed using exact χ² test or Wilcoxon U-tests as appropriate, with a P value <.05. Results: Ninety-six patients received usual-dose and 57 received high-dose corticosteroids. Eighteen (11.8%) patients were transferred within 24 hours of PICU admission and started on SUP on the floor. Thirteen (8.5%) patients were discharged home from the PICU. The remaining 122 (79.7%) patients were transferred from PICU to the floor and there was no statistical difference for continuation of SUP on the floor between usual-dose versus high-dose group, 58 (76.3%) versus 31 (67.4%) patients, P = .282. Overall, 25 of 153 (16.3%) patients were discharged home on SUP, but there was no difference between groups. SUP-associated ADEs did not differ between groups. Conclusions: SUP continuation during transitions of care in this cohort was common. Assessment of SUP continuation is needed during transitions of care to promote SUP stewardship and limit risk of SUP-associated ADEs.