Association Between Early Intravenous Corticosteroids and Length of Stay in Pediatric Laboratory-confirmed Eosinophilic Asthma

Abstract

Background:

In pediatric eosinophilic asthma attacks, every minute of delayed treatment can stretch a child’s suffering and hospital stay. Corticosteroids are a proven therapy, yet the critical timing for intravenous administration has never been clearly defined.

Objective:

To examine whether the timing of intravenous corticosteroid (IVCS) administration influences hospital length of stay (LOS) in children with eosinophilic asthma exacerbation.

Methods:

We conducted a retrospective cohort study at Wangaya General Hospital, Denpasar (2022–2025) involving children aged 2–17 years admitted with acute asthma exacerbation and laboratory-confirmed eosinophilia. Exclusion criteria included no intravenous IVCS in the emergency department, outpatient care, major comorbidities, or incomplete records. Patients were classified into early (<60 minutes) and delayed (>60 minutes) IVCS administration groups. Bivariate tests identified candidate variables, which were then entered into a multiple linear regression.

Results:

Sixty patients were analyzed (mean age 9.26±5.13 years; 58% male). The mean LOS was 3.58 ± 2.23 days. In bivariate analysis, leukocytosis (p=0.039) and delayed IVCS administration (p<0.001) were associated with longer LOS; other factors showed no significance. Children receiving IVCS after 60 minutes stayed longer (4.51 ± 2.78 days versus 2.66 ± 0.79 days). Multivariate analysis confirmed delayed IVCS as an independent predictor of prolonged LOS (B = –0.173; p<0.001) after adjusting for leukocyte count.

Conclusion:

Timely intervention is critical from the very first moment when a child with eosinophilic asthma arrives at the hospital. Administering intravenous corticosteroids within the first hour can significantly shorten recovery and discharge time, underscoring the urgency for rapid intervention.