PURPOSE: Asthma exacerbations are one of the most common causes of hospitalization in children and they account for approximately ten thousand intensive care unit (ICU) admissions per year in the United States. Despite the prevalence of this disease in children, the risk factors for the development of these more severe exacerbations are unknown. The purpose of this retrospective case-control study was to investigate the factors associated with the development of severe asthma exacerbations in children.
METHODS: We conducted a retrospective case-control study of all children admitted to the hospital with asthma for a one-year period between July 2008 and July 2009. Data were collected regarding asthma history including triggers for that exacerbation, types and duration of symptoms, and controller medications used. Predictors and outcomes of children admitted to the ward and to the ICU were compared.
RESULTS: One hundred and eighty-eight children were hospitalized with asthma during the study period, 57 (30%) of whom required admission to the ICU. There were no differences in age, gender or race between the two groups. Children admitted to the ICU were significantly more likely to have an allergy triggered exacerbation than children admitted to the ward (OR 3.9; 95% CI 1.9-8.2; p=0.0003). Additionally, children in the ICU had a significantly shorter duration of illness before being admitted to the hospital compared to those admitted to the ward (1.7 ± 2.3 vs. 3.4 ± 4.8 days; p=0.002). Month of admission was a significant factor as well. In both August and October, children were significantly more likely to be admitted to the ICU versus the ward (OR 9.8, 95% CI 1.1-89.9 in August; OR 2.7, 95% CI 1.2-6.2 in October).
CONCLUSION: In this small study of children, severe asthma exacerbations requiring ICU admission were often triggered by allergies, resulting in a rapidly progressing illness.
CLINICAL IMPLICATIONS: Allergic reactions, possibly triggered by seasonal changes, may increase the incidence of ICU admissions for severe asthma exacerbations.
DISCLOSURE: Kathleen Sala, No Financial Disclosure Information; No Product/Research Disclosure Information