Intravenous Dexamethasone Use and Outcomes in Children Hospitalized With Septic Arthritis.

Abstract

Background: Septic arthritis is routinely treated with joint drainage and antibiotics; however, adjunctive systemic corticosteroids may improve outcomes.

Objectives: To (1) describe variation in intravenous dexamethasone use and (2) evaluate the association of intravenous dexamethasone use with outcomes among children hospitalized with septic arthritis.

Methods: This is a retrospective cohort study of hospitalized children using the Pediatric Health Information System database. We identified intravenous dexamethasone use (on hospital days 0-2) in children with an International Classification of Diseases, Tenth Revision discharge code for septic arthritis (M00.x). The primary outcome was hospital length of stay (LOS). Secondary outcomes included costs, postdrainage imaging, opioid use, repeat drainage procedures, and 30-day emergency department or hospital revisits. We used propensity score matching to account for measured differences between dexamethasone recipients and nonrecipients.

Results: We identified 3524 hospitalizations across 47 hospitals from 2016 to 2020. The median rate of dexamethasone use across hospitals was 28% (IQR, 19%-44%). In the propensity-matched cohort, dexamethasone was associated with shorter LOS (100.5 vs 114.3 hours, P < .001) and lower costs ($16 660 vs $18 243, P = .01) but greater opioid use (odds ratio [OR], 3.80; 95% CI, 1.49-9.70; P < .01). There were no significant differences in 30-day revisits (OR, 0.97; 95% CI, 0.73-1.29; P = .84), postdrainage computed tomography or magnetic resonance imaging (OR, 0.91; 95% CI, 0.71-1.15; P = .42), or repeat drainage procedures (OR, 1.01; 95% CI, 0.81-1.25; P = .94).

Conclusion: In this large cohort study, children with septic arthritis receiving dexamethasone had shorter hospital LOS and costs without higher 30-day revisit rates. Dexamethasone use varied widely across hospitals. These findings highlight the need for evaluation in a multicenter randomized trial.