Carroll Christopher L, Uygungil Burcin, Zucker Aaron R, Schramm Craig M
Department of Pediatrics, Connecticut Children's Medical Center, Hartford, Connecticut 06106, USA.
J Asthma. 2010 May;47(4):460-4. doi: 10.3109/02770903.2010.481344.
Children are frequently admitted to hospitals for treatment of severe asthma exacerbations. Anecdotally, a cohort of these children are thought to have multiple readmissions to the intensive care unit (ICU), yet this group of children has not been characterized. The purpose of this study was to examine the factors related to recurrent ICU admissions in children with asthma.
The authors conducted a retrospective study of all children admitted to the pediatric ICU for asthma between April 1997 and December 2007. Children with more than one ICU admission were defined as having recurrent near-fatal asthma exacerbations.
During this period, 306 children with asthma were admitted to the ICU on 350 occasions; 269 children had only one ICU admission and 33 children (11%) had two or more ICU admissions. To predict who might require readmission, the authors compared the first hospitalization of all children. When compared with children admitted to the ICU only once, children admitted to the ICU more than once were more likely to be overweight (odds ratio [OR] 2.3; 95% confidence interval [CI] 1.1, 4.9), to have public insurance (OR 3.6; 95% CI 1.5, 8.5), and less likely to be Caucasian (OR 0.34; 95% CI 0.14, 0.86). There was no difference in Nation Heart, Lung and Blood Institute (NHLBI) asthma classification, admission illness severity, durations of therapy, or length of stay (LOS) that might identify those who would require readmission. To determine the effect of readmission analysis on subsequent hospitalization, the authors used multiple logistic regression to identify factors associated with increased LOS in all hospitalizations of the subset of children with recurrent near-fatal asthma exacerbations. In this analysis, LOS was most closely associated with admission severity of illness (p = .002), but not with number of hospitalizations.
In this single hospital cohort, there were identifiable factors in children admitted to the ICU that are associated with an increased risk of developing recurrent near-fatal asthma exacerbations. Specifically, overweight children with public insurance were more likely and Caucasian children less likely to be readmitted to the ICU for asthma. These children may represent a group to which specific interventions should be targeted prospectively to prevent readmission.
儿童经常因严重哮喘发作而住院治疗。据传闻，这群儿童中有一部分被认为会多次入住重症监护病房（ICU），但这组儿童尚未得到明确界定。本研究的目的是探讨与哮喘儿童再次入住ICU相关的因素。
作者对1997年4月至2007年12月期间因哮喘入住儿科ICU的所有儿童进行了一项回顾性研究。多次入住ICU的儿童被定义为患有复发性近致命性哮喘发作。
在此期间，306名哮喘儿童共350次入住ICU；269名儿童仅入住ICU一次，33名儿童（11%）入住ICU两次或更多次。为了预测哪些儿童可能需要再次入院，作者比较了所有儿童的首次住院情况。与仅入住ICU一次的儿童相比，多次入住ICU的儿童更有可能超重（优势比[OR]2.3；95%置信区间[CI]1.1，4.9），拥有公共保险（OR 3.6；95%CI 1.5，8.5），且不太可能是白种人（OR 0.34；95%CI 0.14，0.86）。美国国立心肺血液研究所（NHLBI）的哮喘分类、入院时疾病严重程度、治疗持续时间或住院时间（LOS）在确定哪些儿童需要再次入院方面没有差异。为了确定再次入院分析对后续住院的影响，作者使用多元逻辑回归来确定与复发性近致命性哮喘发作儿童亚组所有住院期间LOS增加相关的因素。在该分析中，LOS与入院时疾病严重程度密切相关（p = 0.002），但与住院次数无关。
在这个单一医院队列中，入住ICU的儿童存在一些可识别的因素，这些因素与复发性近致命性哮喘发作风险增加相关。具体而言，拥有公共保险的超重儿童再次入住ICU治疗哮喘的可能性更大，而白种儿童可能性较小。这些儿童可能是应前瞻性地针对其进行特定干预以预防再次入院的群体。
