Corticosteroid Use in Management of Pediatric Emergency Conditions (Pharmacology CME) -
Publication Date: March 2018 (Volume 15, Number 3)
CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. CME expires 3/1/2021
Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Pharmacology CME credits, subject to your state and institutional approval.
Asalim Thabet, MD
Assistant Professor, Departments of Emergency Medicine & Pediatrics, SUNY Upstate Medical University, Syracuse, NY
Tyler Greenfield, DO
Medical Director, Pediatric Emergency Department Upstate University Hospital; Assistant Professor of Emergency Medicine & Pediatrics SUNY Upstate Medical University, Syracuse, NY
Richard M. Cantor, MD, FAAP, FACEP
Professor of Emergency Medicine and Pediatrics; Section Chief, Pediatric Emergency Medicine; Medical Director, Upstate Poison Center, Upstate Medical University, Syracuse, NY
Augusta J. Saulys, MD, FAAP, FACEP
Associate Director, UCSF Benioff Children’s Hospital Oakland Emergency Department; Clinical Professor, Departments of Pediatrics and Emergency Medicine, UCSF School of Medicine
Catherine Sellinger, MD
Assistant Professor of Pediatrics, Albert Einstein College of Medicine; Associate Director, Pediatric Emergency Services, Children’s Hospital at Montefiore, Bronx, NY
Corticosteroids have been used for over half a century to treat various inflammatory disorders; however, their use in many pediatric conditions remains controversial. This issue reviews evidence on corticosteroid treatment in acute asthma exacerbations, croup, acute pharyngitis, anaphylaxis, acute spinal injury, and bacterial meningitis. While corticosteroids are clearly indicated for management of asthma exacerbations and croup, they are not universally recommended for potential spinal cord injury. Due to insufficient data or conflicting data, corticosteroids may be considered in children with acute pharyngitis, anaphylaxis, and bacterial meningitis.
Excerpt From This Issue
An otherwise-healthy 3-year-old boy presents to the ED after awakening in the middle of the night with a barky cough, gasping for air. His mother denies other symptoms and states that foreign body aspiration is unlikely. Upon arrival to the ED via ambulance, the boy continues to have a barky cough and inspiratory stridor with agitation, but no stridor at rest. His physical examination is otherwise unremarkable and his airway is patent, without any evidence of compromise. What are the next steps in the management of this patient? Are corticosteroids indicated in this situation? If so, which one should you prescribe, and at what dosage?
A 13-year-old adolescent girl with a past history of recurrent tonsillitis presents because of progressively worsening pain, increasing dysphagia, decreased oral intake, muffled voice, and unremitting fevers, despite being on an appropriate oral antibiotic. The girl states the illness began with a sore throat, headache, fever, and abdominal pain 4 days ago. On physical examination, she has 4+ right tonsillar enlargement with exudate. Her rapid strep test is positive. A CT scan was ordered to rule out deep space infection, and it showed no sign of phlegmon or abscess. The girl's airway is patent. You begin to consider how you should manage this patient. You decide to consult ENT, and they recommend changing the antibiotic and administering a dose of corticosteroids. Do you agree that corticosteroids are warranted? If so, which corticosteroid should you prescribe, and at what dosage?
D. B. - 09/07/2018 well written and concise.
John Boulet, MD - 09/03/2018 This was one of your best -- and most practical -- articles. I love the fact that PEMP is willing to shoot down so-called "dogma" about supposedly standard of care treatments that are simply NOT proven to work! For example, I was never convinced of the evidence for steroids in spinal cord injury -- I feel vindicated when I see the evidence against it laid out so plainly in your great article today. Thank you!
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