Emergency Department Revisits for Pediatric Acute Asthma Exacerbations

Department of Pediatrics, Children's Mercy Hospital and University of Missouri Kansas City, Kansas City, MO 64108, USA.
Pediatric emergency care (Impact Factor: 1.05). 08/2008; 24(8):505-10. DOI: 10.1097/PEC.0b013e318180fdcb
Source: PubMed


To identify clinical variables associated with a greater likelihood of emergency department (ED) revisit for acute asthma within 7 days after an initial ED visit for acute asthma exacerbation.
Cross-sectional study of subjects from a prospectively enrolled cohort of children aged 0 to 18 years with physician-diagnosed asthma in the ED Allies Tracking System. Demographics and data on quality of life, health care utilization, environmental factors, chronic asthma severity, and ED management were collected. Emergency department revisits for acute asthma within 7 days of a prior visit resulting in discharge were compared with those without a revisit, using chi2 and t tests and logistic regression.
Four thousand two hundred twenty-eight ED asthma visits were enrolled; 3276 visits resulted in discharge. Persistent asthma was identified in 66% of visits. Emergency department revisits within 7 days of a prior visit occurred following 133 (4.1%) visits. There were no significant differences in environmental factors or ED management between visits with and without an ED revisit. In univariate analysis factors associated with a greater revisit likelihood included age younger than 2 years, black race or Hispanic ethnicity, persistent asthma, public insurance, lower quality of life, and greater health care utilization in the prior 12 months. Variables independently significant (P < 0.05) in logistic regression were chronic asthma severity classified as persistent, age younger than 2 years, and lower asthma quality of life.
Although our design precludes drawing causal inference, our results suggest that children younger than 2 years or with persistent asthma or lower asthma quality-of-life scores are at greater risk for ED revisits after acute ED asthma care.

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    • "The ability to predict severe asthma exacerbations would therefore have direct prognostic significance and might form the basis for the development of novel therapeutic interventions. Severe asthma exacerbations have been associated with several clinical factors including the forced expiratory volume in one second as a percent of predicted (FEV1%), oral corticosteroid usage [9,19], age [20], and sex [21]. However, these factors by themselves are limited in their ability to successfully predict severe asthma exacerbations [21,22]. "
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