RESULTS
The total study sample was 106 encounters. In 63 (59%) of these
encounters, corticosteroid were prescribed; Table 1 summarizes encounter
characteristics according to steroid administration. Fifty-three
patients were represented by the 106 encounters, 11 patients (21%) were
never given a steroid over all their hospitalizations and 27 patients
(51%) were always administered a steroid, while the remainder (28%)
had hospitalizations with and without steroids given. Twenty-nine (55%)
of our study sample was hospitalized once, 19% was hospitalized twice,
and 17% experiences ≥3 hospitalizations.
Our analyses revealed that >98% of documented reasons for
steroid use was for poor improvement in clinical response. In our
overall sample, encounters in which patients were given steroids had
less improvement at midpoint (average percent change from admission in
FEV1pp=4.9, SD=11.3) than encounters in which patients were not given
steroids (average percent change in FEV1pp=20.1, SD=24.6;
p-value<0.001; Table 1).
Because of the potential for confounding by indication, we generated a
propensity score matched (PS-matched) sample, which controlled for the
non-equivalent likelihood of steroid use in the overall sample. The
PS-matched sample included 25 matched encounters, representing 36
patients total (Table 2, Figure 2). In the PS-matched sample, there was
no longer a significant difference between groups for the change in
FEV1pp at midpoint (p-value=0.661). FEV1pp did not differ between groups
at baseline, at admission, or at discharge in either the overall sample
or the PS-matched sample.