Divisions of Asthma Research.
Hospital Medicine.
Pediatrics. 2015 Feb;135(2):271-9. doi: 10.1542/peds.2014-2230. Epub 2015 Jan 19.
Asthma heterogeneity causes difficulty in studying and treating the disease. We built a comprehensive statewide repository linking questionnaire and medical record data with health outcomes to characterize the variability of clinical practices at Ohio children's hospitals for the treatment of hospitalized asthma.
Children hospitalized at 6 participating Ohio children's hospitals for asthma exacerbation or reactive airway disease aged 2 to 17 were eligible. Medical, social, and environmental histories and past asthma admissions were collected from questionnaires and the medical record.
From December 2012 to September 2013, 1012 children were enrolled. There were significant differences in the population served, emergency department and inpatient practices, intensive care unit usage, discharge criteria, and length of stay across the sites (all P < .0001, total n = 1012). Public insurance was highest in Cleveland and Cincinnati (72 and 65%). In the emergency department, Cincinnati and Akron had the highest intravenous magnesium sulfate use (37% and 33%); Columbus administered the most intramuscular epinephrine (15%). Cleveland and Columbus had the highest intensive care unit admittance (44% and 41%) and proportion of long-stay patients (95% and 85%). Moderate/severe asthma severity classification was associated with discharge prescription for inhaled corticosteroids (odds ratio = 2.7; 95% confidence interval: 1.6-4.5; P = .004) but not stay length.
These data highlight the need for standardization of treatment practices for inpatient asthma care. There is considerable opportunity for personalized care plans that incorporate a patient's asthma impairment, risk, and treatment response history into hospital practices for asthma exacerbation treatment. The Ohio Pediatric Asthma Repository is a unique statewide resource in which to conduct observational, comparative effectiveness, and ultimately intervention studies for pediatric asthma.
哮喘的异质性导致研究和治疗该病具有难度。我们建立了一个全面的全州范围的存储库，将问卷和病历数据与健康结果联系起来，以描述俄亥俄州儿童医院治疗住院哮喘的临床实践的可变性。
在 6 家参与的俄亥俄州儿童医院因哮喘加重或反应性气道疾病住院的 2 至 17 岁儿童符合入选标准。从问卷和病历中收集了医疗、社会和环境病史以及过去的哮喘入院情况。
2012 年 12 月至 2013 年 9 月，共纳入 1012 名儿童。各医院收治的人群、急诊科和住院部的治疗方法、重症监护室的使用、出院标准和住院时间存在显著差异（所有 P 值均<.0001，总计 n = 1012）。克利夫兰和辛辛那提的公共保险覆盖率最高（72%和 65%）。在急诊科，辛辛那提和阿克伦的静脉用硫酸镁使用率最高（37%和 33%）；哥伦布使用的肌肉内肾上腺素最多（15%）。克利夫兰和哥伦布的重症监护室收治率最高（44%和 41%）和长期住院患者比例最高（95%和 85%）。中重度哮喘严重程度分类与吸入性皮质激素的出院处方相关（比值比=2.7；95%置信区间：1.6-4.5；P =.004），但与住院时间无关。
这些数据突出表明，需要对住院哮喘治疗的治疗实践进行标准化。为哮喘加重治疗，有很大机会将患者的哮喘损害、风险和治疗反应史纳入医院治疗方案，制定个性化的护理计划。俄亥俄州儿科哮喘数据库是一个独特的全州资源，可用于开展儿科哮喘的观察性、比较有效性，最终是干预性研究。
