Children who are hospitalized for asthma and admitted to the intensive care unit (ICU) have a higher risk of being readmitted for another asthma-related cause compared with children hospitalized but not admitted to the ICU, according to study results published in the Journal of Asthma.
The study was a retrospective analysis of children between the ages of 2 and 17 years from 4 US states who were included in the State Inpatient Database (2005-2014). Only children who were hospitalized for asthma were included in the analysis (N=66,835). Investigators compared children admitted to the ICU with children not admitted to the ICU with regard to the time to asthma-related admission and emergency department (ED) visit. In addition, the researchers examined factors associated with readmission among patients initially admitted to the ICU.
Children were from Florida, New York, Arkansas, and Nebraska, and the median length of stay was 2 days. Approximately 14.0% (n=9377) of the cohort were admitted to the ICU. A total of 12,844 children were readmitted for asthma and 22,915 had an asthma-related ED visit. The ICU group demonstrated a shorter median time to asthma-related readmission vs the non-ICU group (30.1 months vs 36.0 months, respectively; P <.001). No difference was found between the 2 groups with regard to the median time to asthma-related ED visit (24.0 months vs 27.0 months, respectively; P =.43).
Factors associated with a higher risk for asthma-related admission in children admitted to the ICU included being of preschool age (odds ratio [OR], 1.31; 95% CI, 1.15-1.49), being female (OR, 1.13; 95% CI, 1.03-1.24), being black (OR, 1.42; 95% CI, 1.26-1.60), having a lower median household income in the first (0-25th; OR, 1.33; 95% CI, 1.15-1.53) or second quartile (26th-50th; OR, 1.18; 95% CI, 1.01-1.38), and having a longer length of stay during the index hospitalization (OR, 1.04; 95% CI, 1.03-1.06).
Factors associated with a higher risk for readmission specifically in Florida and New York included younger age (2-5 years: OR, 1.53 [95% CI, 1.26-1.86]; 6-11 years: OR, 1.39 [95% CI, 1.14-1.70]) and being on Medicaid (OR, 1.27; 95% CI, 1.08-1.51). Being of Hispanic ethnicity was a New York-specific factor only (OR, 1.40; 95% CI, 1.13-1.74).
Limitations of the study included its retrospective design, the inclusion of patients from only 4 US states, and the lack of data on potential determinants of asthma-related readmission (eg, tobacco smoke exposure, asthma phenotype, medication adherence, etc).
The researchers concluded that “long-term follow-up of these patients with careful monitoring of their asthma symptoms is warranted.”
Jroundi I, Tse SM. Long-term asthma-related readmissions: comparison between children admitted and not admitted to the intensive care unit for critical asthma [published online September 6, 2019]. J Asthma. doi:10.1080/02770903.2019.1663430