Andrews Annie L, Shirley Nils, Ojukwu Elizabeth, Robinson Michelle, Torok Michelle, Wilson Karen M
Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina;
Medical University of South Carolina College of Medicine, Charleston, South Carolina;
Hosp Pediatr. 2015 May;5(5):249-55. doi: 10.1542/hpeds.2014-0128.
To determine the association between secondhand smoke (SHS) exposure and length of stay (LOS) and other exacerbation severity indicators in children hospitalized for asthma.
We conducted a retrospective chart review at 2 children's hospitals. Patients aged 2 to 18 hospitalized for asthma in 2012 were included. Outcome variables included LOS, PICU, magnesium, and intravenous (IV) steroids. Bivariate analysis determined differences between SHS-exposed and non-SHS-exposed groups. Geometric means were used for LOS to account for skewed distribution. Logistic and zero-truncated negative binomial regression models were used to determine the independent association between SHS exposure and hospitalization severity indicators.
A total of 623 patients were included; 41% reported SHS exposure. Mean LOS was 47.5 hours. In the SHS-exposed group, LOS was 50.0 (95% confidence interval [CI] 46.7-54.0) and in the nonexposed group it was 45.8 (95% CI 43.4-48.4) (P = .02). In regression analysis, institution modified the effect of SHS exposure on LOS. At Children's Hospital Colorado, SHS exposure was associated with a 20% increase in LOS (incidence rate ratio 1.2, 95% CI 1.1-1.3). At the Medical University of South Carolina, there was no significant association. SHS-exposed patients were more likely to receive IV steroids (odds ratio 1.6, 95% CI 1.1-2.3) CONCLUSIONS: Among children hospitalized for asthma, we identified a significant association at 1 institution between SHS exposure and LOS and found that IV steroid use was significantly associated with LOS at both institutions. Eliminating SHS exposure among children with asthma is important.
确定因哮喘住院儿童的二手烟暴露与住院时间及其他加重严重程度指标之间的关联。
我们在两家儿童医院进行了一项回顾性病历审查。纳入2012年因哮喘住院的2至18岁患者。结局变量包括住院时间、儿科重症监护病房（PICU）、镁和静脉注射（IV）类固醇。双变量分析确定了二手烟暴露组和非二手烟暴露组之间的差异。住院时间采用几何均数来处理分布偏态。使用逻辑回归和零截断负二项回归模型来确定二手烟暴露与住院严重程度指标之间的独立关联。
共纳入623例患者；41%报告有二手烟暴露。平均住院时间为47.5小时。在二手烟暴露组，住院时间为50.0小时（95%置信区间[CI]46.7 - 54.0），在非暴露组为45.8小时（95%CI 43.4 - 48.4）（P = 0.02）。在回归分析中，机构改变了二手烟暴露对住院时间的影响。在科罗拉多儿童医院，二手烟暴露与住院时间增加20%相关（发病率比1.2，95%CI 1.1 - 1.3）。在南卡罗来纳医科大学，未发现显著关联。二手烟暴露患者更有可能接受静脉注射类固醇（优势比1.6，95%CI 1.1 - 2.3）。结论：在因哮喘住院的儿童中，我们在一家机构发现二手烟暴露与住院时间之间存在显著关联，并发现两家机构中静脉注射类固醇的使用均与住院时间显著相关。消除哮喘儿童的二手烟暴露很重要。
