Corticosteroid Prescribing Patterns in the Emergency Department for Acute COPD Exacerbations: A Retrospective Analysis Following an Educational Intervention

Christopher Nedzlek; Jacob Blanchett; Zachary Illg; Geoffrey DiGiacinto; Kathryn Cunningham; Samuel J Wisniewski; Jacob Tuttle

doi:10.51894/001c.124542

Corticosteroid Prescribing Patterns in the Emergency Department for Acute COPD Exacerbations: A Retrospective Analysis Following an Educational Intervention

Spartan Med Res J. 2024 Sep 10;9(3):124542. doi: 10.51894/001c.124542. eCollection 2024.

Authors

Christopher Nedzlek¹, Jacob Blanchett¹, Zachary Illg¹, Geoffrey DiGiacinto¹, Kathryn Cunningham¹, Samuel J Wisniewski², Jacob Tuttle¹

Affiliations

¹ Department of Emergency Medicine Henry Ford Wyandotte Hospital, Wyandotte, MI, USA.
² College of Osteopathic Medicine Statewide Campus System, East Lansing, MI, USA Michigan State University.

Abstract

Introduction: COPD is a progressive lung disease with marked airflow limitation. It has a large global prevalence and is managed with antibiotics, bronchodilators, and corticosteroids. Despite the prevalence, corticosteroid prescribing regimens differ widely amongst providers. This study aims to evaluate baseline corticosteroid prescribing patterns, the ability to change corticosteroid prescribing patterns with the utilization of an educational initiative, and to evaluate the effect of corticosteroid dose on length of stay, 30-day hospital readmission, mortality, and total hospital insulin dosing.

Methods: This study was conducted via a retrospective observational study. Providers at a single institution answered a baseline questionnaire on COPD corticosteroid prescribing patterns and subsequently received an educational presentation regarding evidence-based corticosteroid recommendations. Data were then retrospectively obtained and analyzed evaluating corticosteroid prescribing patterns both pre- and post-educational intervention. Data were analyzed using IBM SPSS Version 25.

Results: The provider survey revealed that most (95.3%) administered 125 mg of methylprednisolone to patients treated for AECOPD. The most common reason a particular dose of corticosteroid was administered was due to previous teaching or practice patterns. The mean initial steroid dose of methylprednisolone decreased following the educational initiative from 114.24 mg to 72.8 mg (p < 0.01). This corresponded to a 69% (n=41) decrease of providers using 125 mg methylprednisolone (p < 0.01), and increased prescribing of 62.5 mg methylprednisolone by 42.6% (n=66). The mean LOS following hospital admission for AECOPD in the pre-intervention group was 5.80 days, while the mean LOS following the targeted educational intervention decreased to 4.82 days (p = 0.01).

Conclusions: The implementation of an educational intervention may change provider corticosteroid prescribing patterns. Additionally, lower corticosteroid dose in the Emergency Department may decrease patient length of stay. Keywords: Corticosteroid, COPD, LOS, recommendations, steroid.

Keywords: COPD; Corticosteroid; LOS; recommendations; steroid.

Grants and funding

None. For reprint requests or correspondence, please contact the authors via mail at 2333 Biddle Avenue, Wyandotte, MI 48192, or via email at cnedzle1@hfhs.org.