PURPOSE:Severe asthma exacerbations are a frequent cause of hospitalization in children. There is thought to be a cohort of children that have multiple readmissions to the ICU for severe exacerbations, however, this cohort has not been well characterized. The purpose of this study was to examine the factors related to repeated ICU admissions in children with asthma.
METHODS:We conducted a retrospective study of all children admitted to the pediatric ICU for asthma between April 1997 and December 2007.
RESULTS:During this period, 304 children were admitted to the ICU on 350 occasions; 269 children had only one ICU admission, 26 children had two ICU admissions, and 9 children were admitted ≥ 3 times. In order to predict who might require readmission, we compared the first hospitalization of these children. When compared to children admitted to the ICU only once, children admitted to the ICU more than once were more likely to be overweight (OR 3.4; 95% CI 1.4, 8.0), to have public insurance (OR 2.4; 95% CI 1.1, 5.3), and to have prior hospitalization for asthma (OR 4.6; 95% CI 1.8, 11.5). There was no difference in NHLBI asthma classification, admission illness severity, durations of therapy, or length of stay (LOS) that might identify those who would require readmission. In order to determine the effect of readmission on subsequent hospitalization, we then used multiple logistic regression to identify factors associated with increased LOS in all hospitalizations. In this analysis, LOS was most closely associated with admission severity of illness, but not with readmission status (p<0.001).
CONCLUSION:Overweight children with public insurance were more likely to be readmitted to the ICU with a severe asthma exacerbation. However, the course of subsequent hospitalizations for asthma was more related to the severity of that particular exacerbation than to readmission status.
CLINICAL IMPLICATIONS:There are identifiable factors associated with an increased risk of repeated ICU admission for asthma. These children represent a population to which specific interventions should be targeted to prevent readmission.
DISCLOSURE:Christopher Carroll, None.