Multiple factors associated with hospital admission for pediatric ... - Healio
March 27, 2023
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Sanosyan A, et al. Abstract 226. Presented at: AAAAI Annual Meeting; Feb. 24-27, 2023; San Antonio.
Disclosures: Sanosyan reports no relevant financial disclosures.
Key takeaways:
- Age, type of asthma, previous ED admission and family history were associated with admission.
- English fluency, insurance status and pulmonologist involvement were not associated with admission.
SAN ANTONIO — Multiple factors may predict whether pediatric patients will be admitted to the hospital for acute asthma exacerbations, according to data presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting.
"We aimed to understand the impact of prehospitalization factors such as demographics, socioeconomic status and chronic asthma management parameters on admission from the ED to the pediatric inpatient unit," Armen Sanosyan, MD, PhD, Washington University in St. Louis, said in his presentation.
Upon arrival at the emergency department, most children with an asthma exacerbation respond well to initial therapy with systemic steroids and bronchodilators; however, some children may develop progressive respiratory distress or failure.
"Admission criteria from the ED to the pediatric floor are based on the assessment of the patient's respiratory status in ED after the first-line treatment," Sanosyan said.
The retrospective case control study reviewed 240 patients aged 1 to 21 years who visited BronxCare Health System EDs for acute asthma exacerbations. Each patient who was admitted to the pediatric ICU was matched with two consecutive patients admitted to the pediatrics floor and three patients who were discharged from the ED.
The differences in ages between those children who were discharged from the ED and those who were admitted to the pediatric ICU (P = .0044) and those who were admitted to the pediatric floor (P < .0001) were significant, the researchers said.
"Although the time between the current and the previous ED visit were not significantly different between the groups, the P value enabled us to include this parameter in a multivariate model," Sanosyan said.
Based on this multivariate model, background factors statistically significantly associated with inpatient pediatric asthma admission compared with discharge from the ED include:
- Age 5 years and older (OR = 0.21; 95% CI, 0.05-0.82; P = .03)
- Moderate persistent vs. intermittent asthma (OR = 5.99; 95% CI, 1.14-41.02; P = .05)
- Previous ED admission more than 12 months previously vs. 12 months or less (OR = 8.72; 95% CI, 1.57-62.33; P = .02)
- One previous admission in the previous year vs. never (OR = 6.48; 95% CI, 1.34-37.94; P = .03)
"The age and severity of asthma are independently associated with admission," Sanosyan said.
Furthermore, mild persistent asthma was not more likely to be associated with admission compared to intermittent asthma, whereas moderate persistent asthma was independently related to admission.
"Although not statistically significant, a trend of association was detected between the family history of asthma and admission," Sanosyan said. "Another trend of association, although an inverse association, was detected between the admission and the fact of having primary care established at the same hospital."
Background factors that were not associated with inpatient pediatric asthma admission included gender, race, English fluency, parental availability, mode of arrival to the ED, established care with a pulmonologist and health insurance.
Sanosyan noted the study's limitations, which included its retrospective nature, the difference in the depth of information included in electronic health records for admitted and discharged patients, and the small number of cases that the multivariate model included.
"We only had 80 cases where all the parameters were available," he said.
However, he continued, the researchers still were able to summarize the differing distribution of background factors among admitted and discharged patients with acute asthma exacerbations.
"Our study justifies assessing these factors for modeling asthma inpatient admission in further studies," Sanosyan said. "Furthermore, the predictive model will enable providers and caregivers to anticipate the level of care required at the onset of acute asthma exacerbation."
Perspective
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Kristina Gaietto, MD
This study assessed whether specific demographic and/or asthma characteristics are associated with increased risk of hospitalization for a child who presents to the emergency department for an asthma exacerbation. The investigators found that age and previous admission in the past year were significantly associated with hospitalization. Identifying risk factors is one of the first steps in working to reduce asthma hospitalizations. We first need to understand who gets hospitalized.
These findings are congruent with my clinical experience. Younger children and those with prior asthma-related ED visits/hospitalizations do seem to be more likely to be admitted for asthma exacerbations. However, these risk factors are not reliably appreciable in individual practice, which is why a study like this one provides valuable insight.
Understanding which patients are at higher risk can help providers identify which patients with asthma may benefit from extra counseling regarding signs and symptoms to seek emergency care. It can also help identify which patients in the ED are more likely to get admitted, which can help with anticipatory counseling to families and with hospital bed assignment flow. However, it is important to acknowledge that a decision to admit vs. send home relies on many factors, especially the specifics of the child's acute presentation.
Next, the authors' proposed predictors and predictor model should be tested in populations of children with asthma at other medical centers to see if these factors remain predictive of hospitalization.
Kristina Gaietto, MD
Clinical Instructor of Pediatrics, Postdoctoral Scholar, Division of Pulmonology, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Childrens Hospital of Pittsburgh
Disclosures: Gaietto reports receiving research funding from T32 Training Grant HL129949 from the NIH.
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