Department of Pediatrics, Duke University, Box 3046, Durham, NC 27710, USA.
Pediatrics. 2010 Oct;126(4):e904-11. doi: 10.1542/peds.2009-3239. Epub 2010 Sep 27.
Status asthmaticus accounts for a large portion of the morbidity and mortality associated with asthma, but we know little about its epidemiology. We describe here the hospitalization characteristics of children with status asthmaticus, how they changed over time, and how they differed between hospitals with and without PICUs.
We used administrative data from New Jersey that included all hospitalizations in the state from 1992, 1995, and 1999-2006. We identified children with status asthmaticus by using International Classification of Diseases, Ninth Revision, diagnosis codes that indicate status asthmaticus and the use of mechanical ventilation by using procedure codes. We designated hospitals with a PICU as "PICU hospitals" and those without as "adult hospitals."
We identified 28 309 admissions of children with status asthmaticus (22.8% of all asthma hospitalizations). From 1992 to 2006, the rate of hospital admissions decreased by half (from 1.98 in 1000 to 0.93 in 1000 children), and there was a 70% decrease in the number of children admitted to adult hospitals. The rate of ICU care in PICU hospitals more than tripled. However, the rate of mechanical ventilation remained low, and the number of deaths was small and unchanged (n=14 total). Hospital costs climbed from $6.6 million to $9.5 million.
Although fewer children are being admitted with status asthmaticus, the proportion of patients managed in PICUs is climbing. There has been no substantial change in rates of mechanical ventilation or death. Additional research is needed to better understand how patients and physicians decide on the appropriate site for hospital care and how that choice affects outcome.
哮喘持续状态在与哮喘相关的发病率和死亡率中占很大比例，但我们对其流行病学知之甚少。我们在此描述哮喘持续状态患儿的住院特征，描述其随时间的变化情况，以及在设有和不设儿科重症监护病房（PICU）的医院之间的差异。
我们使用了新泽西州的行政数据，该数据包含了 1992 年、1995 年和 1999-2006 年期间全州所有的住院情况。我们通过使用表明哮喘持续状态的国际疾病分类，第九版诊断代码和通过手术代码使用机械通气来识别哮喘持续状态患儿。我们将设有 PICU 的医院指定为“PICU 医院”，而将没有 PICU 的医院指定为“成人医院”。
我们确定了 28309 例哮喘持续状态患儿的住院情况（占所有哮喘住院情况的 22.8%）。从 1992 年到 2006 年，住院率下降了一半（从每千名儿童 1.98 例降至每千名儿童 0.93 例），而且到成人医院就诊的患儿数量减少了 70%。PICU 医院的 ICU 护理率增加了两倍多。但是，机械通气的比例仍然较低，死亡人数很少且保持不变（总共 14 例）。医院费用从 660 万美元增加到 950 万美元。
尽管患有哮喘持续状态的患儿人数有所减少，但在 PICU 接受治疗的患儿比例正在上升。机械通气或死亡的发生率没有实质性变化。需要进一步研究以更好地了解患者和医生如何决定适当的住院治疗地点，以及该选择如何影响结果。
