Characteristics of Pediatric Emergency Revisits After an Asthma-Related Hospitalization - 29/08/17
, Andrew F. Beck, MD, MPH b, c, Robert S. Kahn, MD, MPH b, Bin Huang, PhD d, Patrick H. Ryan, PhD d, Kelly K. Olano, BS, BA d, Katherine A. Auger, MD, MSc cAbstract |
Study objective |
We identify and characterize factors related to subsequent emergency revisits among children hospitalized for asthma.
Methods |
This population-based, prospective, observational cohort included children aged 2 to 16 years, hospitalized for asthma at an urban pediatric facility and followed for greater than or equal to 12 months. The primary outcome was asthma-related emergency revisit within 12 months of discharge. Revisits were identified by billing codes, respiratory chief complaints, and medications administered (eg, albuterol, systemic corticosteroids), dispensed, or prescribed. Predictors and covariates include demographic, socioeconomic, access, and environmental exposure variables collected during index admission. Multivariable logistic regression was used to evaluate the association between predictors and odds of asthma-related revisit.
Results |
A total of 671 children were enrolled; the majority were boys (65%), aged 4 to 11 years (59%), black (59%), and publicly insured (73%). There were 274 patients (41%) who were treated for asthma-related emergency revisits within 12 months of the index admission. In adjusted models, younger children, black children, children with excellent reported access to primary care, and children with a history of inhaled steroids were more likely to experience emergency revisits. Low income, detectable cotinine levels, and traffic exposure did not independently predict revisit.
Conclusion |
Asthma-related emergency revisit is common after hospitalization, with more than 40% of children returning within 12 months. Socioeconomic and exposure-related risk factors typically predictive of asthma morbidity were not independently associated with emergency revisit among children in this cohort.
Le texte complet de cet article est disponible en PDF.Plan
| Please see page 278 for the Editor’s Capsule Summary of this article. |
|
| Supervising editor: Kathy N. Shaw, MD, MSCE |
|
| Author contributions: LHJ, AFB, RSK, BH, PHR, and KAA conceived the study. AFB and RSK obtained funding. LHJ, RSK, and BH supervised the data collection and managed the data, including quality control. BH and PHR provided statistical advice on study design. BH analyzed data. LHJ and KAA drafted the article, and all authors contributed substantially to its revision. LHJ takes responsibility for the paper as a whole. |
|
| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
|
| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist. The Greater Cincinnati Asthma Risk Study was funded by a grant from the National Institutes of Health (NIH) to Dr. Kahn (1R01AI88116). Dr. Beck received funding from the NIH through a career development award (1K23AI112916). |
|
| Readers: click on the link to go directly to a survey in which you can provide QC79C3R to Annals on this particular article. |
|
| A podcast for this article is available at www.annemergmed.com. |
Vol 70 - N° 3
P. 277-287 - septembre 2017 Retour au numéro
Article précédent
- Is Tachycardia at Discharge From the Pediatric Emergency Department a Cause for Concern? A Nonconcurrent Cohort Study
- Paria M. Wilson, Todd A. Florin, Guixia Huang, Matthew Fenchel, Matthew R. Mittiga
- Cluster Analysis of Acute Care Use Yields Insights for Tailored Pediatric Asthma Interventions
- Mahshid Abir, Aaron Truchil, Dawn Wiest, Daniel B. Nelson, Jason E. Goldstick, Paul Koegel, Marie M. Lozon, Hwajung Choi, Jeffrey Brenner
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?