Crowding in the emergency department (ED) was found to be associated with worse short-term outcomes in children with low to moderate vs more severe asthma, according to a study published in Pediatric Research.

This was a retrospective analysis of data collected between 2015 and 2018 from a population-based health administrative databases from Alberta, Canada. Only data from the province’s 18 highest-volume EDs that had >30,000 visits per year were included in the study. The National Ambulatory Care Reporting System was used to extract ED presentation information, which was linked to the cumulative registry file, physician claim file, and discharge abstract database.

The study population consisted of children between the ages of 2 and 17 years who presented to the ED with a primary (n=16,053) or secondary (n=25,383) asthma diagnosis. The hourly and facility-specific median time to physician initial assessments were calculated for all patients.

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The median time to initial assessment by a physician was 50 minutes (interquartile range [IQR], 27-93 minutes). Pediatric patients who had less vs more severe disease had longer time to initial assessment. After adjusting for predictors, the individual-level time to physician initial assessment increased by 13 minutes (95% CI, 12-14), 43 minutes (95% CI, 42-44), and 60 minutes (95% CI, 58-61), for every 1-hour increase in median facility time to physician initial assessment for children with severe, moderate, and low acuity asthma, respectively.

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For high, moderate, and low acuity groups, the length of stay increased by 6 minutes, 36 minutes, and 45 minutes, respectively for every 1-hour increase in median facility time to physician initial assessment. Increased time to physician initial assessment led to a greater number of ED departures before care was completed for the moderate acuity (adjusted odds ratio [OR], 4.72; 95% CI, 3.09-7.21) and low acuity (unadjusted OR, 2.37; 95% CI, 1.345-4.18) groups.

Limitations of this study include its retrospective nature and the use of time to physician initial assessment to capture ED crowding.

“Since crowding adversely affects short-term outcomes of pediatric patients with asthma, efforts to reduce ED crowding and assess patients with asthma in a more timely manner are needed,” concluded the study authors.


Sagaidak S, Rowe BH, Ospina MB, Rosychuk RJ. Emergency department crowding negatively influences outcomes for children presenting with asthma: a population-based retrospective cohort study [published online April 28, 2020]. Pediatr Res. doi: 10.1038/s41390-020-0918-2