Obstructive Lung Diseases: Asthma Guidelines and Outcomes |

Outcomes in Patients Presenting With Asthma to the Emergency Room in 2011 FREE TO VIEW

Shruti Gadre, MD; Sami Abuqayyas, MD; Susan Combs, MD; Pejman Raeisi-Giglou, MD; Joe Zein, MD
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Cleveland Clinic Foundation, Cleveland, OH

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):888A. doi:10.1016/j.chest.2016.08.988
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SESSION TITLE: Asthma Guidelines and Outcomes

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 23, 2016 at 07:30 AM - 08:30 AM

PURPOSE: To describe the outcomes of patients presenting to the emergency room with asthma as a primary diagnosis and to identify risk factors associated with hospitalization, respiratory failure and mortality.

METHODS: We analyzed the 2011 Healthcare Cost and Utilization Project- Nationwide Emergency Department Sample (NEDS) database. The International Classification of Disease, ninth revision (ICD9-CM) codes of 493.XX were used to identify patients admitted with a principal diagnosis of asthma. Patients were excluded if they had a secondary diagnosis of chronic obstructive pulmonary disease, bronchiolitis with Respiratory Syncytial Virus, were active or past smokers, or if they had a chronic lung disease diagnosed as a comorbidity.

RESULTS: In 2011, 1,942,429 emergency room (ER) visits were recorded with a primary diagnosis of asthma resulting in 326,585 (16.8%) hospitalizations and 1,039 (0.32%) deaths. 55,915 patients developed respiratory failure. A greater proportion of women were admitted to the hospital compared to men (205,259 vs. 121,317; p = 0.0003). Asthma mortality was higher in women than in men across all age groups (685 vs. 354; p = 0.003). Asthma mortality was independently associated with age (OR: 1.03; 95% CI 1.02-1.04 per year), number of chronic illnesses (OR: 1.12; 95% CI 1.10-1.14 per comorbidity) and weekend admission (OR: 1.39; 95% CI 1.05-1.84). A restricted cubic spline model with 3 knots was fitted to describe the nonlinear relationship between age and risk for hospitalization and respiratory failure, which were highest among children and older adults. Asthma hospitalization was associated with the number of chronic illnesses (OR: 1.56; 95% CI 1.55-1.57), GERD (OR: 1.32; 95% CI 1.27-1.38) and socioeconomic conditions. Hospitalization risk was higher in Medicaid as compared to Medicare beneficiaries (OR: 1.3; 95% CI 1.25-1.35) and in zip-codes with lower income. The ER charges (Median [IQR]: $295[778; 2092]) increased linearly with patient age. They were higher in women (Median [IQR]: $1354 [811; 2220]) as compared to men (Median [IQR]: $1234[761; 1939]) across all ages (p<0.001). Median hospital charges were higher in women as compared to men ($15,267 vs. $11,807).

CONCLUSIONS: Asthma exacerbations are a common cause of presentation to the ER. A significant proportion of patients require admission to the hospital for treatment contributing to a significant health care cost. Age, socioeconomic status and number of chronic illnesses are associated with risk of hospitalization and mortality.

CLINICAL IMPLICATIONS: There is a significant mortality, morbidity and health care cost associated with the treatment of asthma in the ER. Lower socioeconomic status contributes to higher hospitalization risk. Women have worse outcomes and higher health care costs and deserve greater attention.

DISCLOSURE: The following authors have nothing to disclose: Shruti Gadre, Sami Abuqayyas, Susan Combs, Pejman Raeisi-Giglou, Joe Zein

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