PECARN study exploring oral steroids for asthma in ambulance setting

Cincinnati Children’s Hospital Medical Center and local Cincinnati EMS agencies from the Pediatric Emergency Care Applied Research Network (PECARN) midwestern research node, HOMERUN, are a major site in a national study of the efficacy of EMS administration of oral steroids to children with asthma exacerbations. The “Early Administration of Steroids in the Ambulance Setting: An Observational Design Trial” or “EASI AS ODT” study is a pragmatic trial using a stepped wedge design, where each site introduces the intervention at a different period in time, rather than all at once. Using this approach, the study is looking at pediatric patient outcomes before and after EMS agencies introduce an oral steroid option for the treatment of asthma attacks. The study is led by Principal Investigator Jennifer Fishe, MD, a pediatric emergency medicine physician and pediatric EMS medical director from the University of Florida College of Medicine-Jacksonville, and is funded by a five-year National Heart, Lung, and Blood Institute K23 award.

“Asthma is the most common chronic childhood disease and a leading cause of emergency department visits,” says Dr. Fishe. “But there is little evidence and few guidelines on the best way for EMS to take care of pediatric asthma attacks while in an unpredictable and mobile environment. We hope to learn if and when oral steroids should be administered, to spare children the painful procedure of placing an IV.”

The study comprises seven sites, including Texas Children’s Hospital and the Houston Fire Department from PECARN’s CHaMP node, joined by five EMS agencies in Florida.

The lead investigator from Cincinnati Children’s, Lauren Riney, DO, assistant professor of pediatrics in the Division of Pediatric Emergency Medicine, stresses the importance of pragmatic pediatric prehospital trials, including ones that are observational in nature: “Because EMS operates in such a unique medical environment, specific prehospital research is needed, and specific pediatric prehospital research is even more vital.”

Dr. Riney adds: “In addition to quantitative EMS data, Cincinnati is hosting focus groups with EMS clinicians for a qualitative analysis to identify barriers and facilitators to administering oral medications to children with asthma. We are already identifying important considerations that are not well-documented in the typical EMS report.”

The qualitative study in Cincinnati is led by Dr. Riney and Alexandra Cheetham, MD, a pediatric emergency medicine fellow, in conjunction with focus groups in Florida led by Dr. Fishe, Kayla McManus, DO, Ramzi Salloum, PhD, and Jennifer Brailsford, PhD, from University of Florida.

Five Easy Facts about “EASI AS ODT”

1. The goal is to examine whether EMS administration of steroids decreases ED admissions and ED length of stay for children with asthma exacerbations.
2. The study is using geographic information system to determine if the benefits of EMS steroids change based on transport time.
3. The study is conducting focus groups of EMS clinicians to hear their voice about barriers and facilitators to pediatric protocol changes and administering oral steroids to children with asthma.
4. The study has seven sites nationwide with great geographic and demographic diversity: Cincinnati, Houston, Nassau County, FL, Lee County, FL, Leon County, FL, Sarasota County, FL, and Walton County, FL.
5. The overall goal is to generate evidence-based guidance that individual EMS agencies can customize for their local operations and patient population.

Pictured, from left to right: Dr. Fishe; Dr. Riney; and Dr. Cheetham.