Tolomeo Concettina, Savrin Carol, Heinzer Marjorie, Bazzy-Asaad Alia
Pediatric Respiratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
J Asthma. 2009 Oct;46(8):829-34.
Asthma is a leading cause of emergency department visits and hospitalizations for children in the United States. As part of a larger study, the purpose of this analysis was to determine which variables were most effective at predicting subsequent pediatric asthma-related emergency department visits and hospitalizations.
A retrospective, descriptive study was conducted. Subjects consisted of a convenience sample of 298 children admitted to a New England Children's Hospital in 2006 with a primary diagnosis of asthma. Data from two hospital databases were collected for 12 months before and 12 months after the 2006 admission. Basic descriptive statistics were followed by chi-square tests to determine which variables were associated with emergency department visits and hospitalizations. Logistic regression analysis was used to determine which variables were significant predictors of asthma-related emergency department visits and hospitalizations.
Sixty-percent of all subjects were male. Ninety subjects experienced a total of 145 emergency department visits and 54 experienced a total of 70 hospitalizations. A previous emergency department visit was a significant predictor of both subsequent emergency department visits and subsequent hospitalizations. Age was also an independent risk factor for subsequent hospitalizations. In this sample, the risk of a hospitalization increased with each year increase in age.
These findings support the importance of early identification of children with asthma so that appropriate asthma management can be instituted before an emergency department visit occurs. Furthermore, results suggest involving school-age and preadolescent children in the care of their asthma so that they can be equipped and encouraged to self-manage their own asthma.
在美国，哮喘是导致儿童前往急诊科就诊和住院的主要原因。作为一项更大规模研究的一部分，本分析的目的是确定哪些变量在预测儿童随后与哮喘相关的急诊科就诊和住院方面最有效。
进行了一项回顾性描述性研究。研究对象为2006年入住新英格兰儿童医院、初步诊断为哮喘的298名儿童的便利样本。收集了2006年入院前12个月和入院后12个月两个医院数据库的数据。在进行基本描述性统计后，采用卡方检验来确定哪些变量与急诊科就诊和住院相关。使用逻辑回归分析来确定哪些变量是哮喘相关急诊科就诊和住院的显著预测因素。
所有研究对象中60%为男性。90名儿童共前往急诊科就诊145次，54名儿童共住院70次。既往的急诊科就诊是随后急诊科就诊和住院的显著预测因素。年龄也是随后住院的独立危险因素。在本样本中，住院风险随着年龄每增加一岁而增加。
这些发现支持了早期识别哮喘儿童的重要性，以便在其前往急诊科就诊之前实施适当的哮喘管理。此外，结果表明应让学龄期和青春期前儿童参与自身哮喘的护理，以便使他们有能力并受到鼓励自我管理哮喘。
