Seshadri Nilesh, Faig Walter, Young Lisa R, Hill David A
Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Department of Biostatistics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Respir Med. 2024 Dec;235:107867. doi: 10.1016/j.rmed.2024.107867. Epub 2024 Nov 16.
Children with severe persistent asthma managed by subspecialists represent a unique patient population. The factors predisposing these children to hospital admission are poorly understood. This study aimed to identify factors associated with future emergency department (ED) visits and hospitalization in this group.
A chart review was conducted for children with severe persistent asthma evaluated by a pulmonologist between January 1, 2021 and June 30, 2022. Asthma-related ED visits and hospitalizations were recorded from electronic medical records. Chi-square testing, mixed effects modeling, and logistic regression were used to analyze associations between patient characteristics and hospitalization. A secondary analysis evaluated factors contributing to ED visits.
We identified 244 unique patients with 487 pulmonary clinic visits. Of these, 56 % were black, 58 % had public insurance, and 32 % had a history of ICU admission for asthma. In the 12 months following a clinic visit, 84 (34 %) patients had an ED visit, and 46 (19 %) had at least one hospitalization. Secondhand smoke exposure (OR 2.74, 95 % CI 1.16-6.45), public insurance (OR 3.37, 95 % CI 1.46-7.82), and prior ICU admission (OR 2.29, 95 % CI 1.09-4.79) were positively associated with hospitalization for asthma exacerbation. Among hospitalized patients, bronchopulmonary dysplasia (BPD) and gastroesophageal reflux disease (GERD) were linked to shorter time to admission.
Despite subspecialty care, children with severe persistent asthma exposed to cigarette smoke, with prior ICU admission, or with public insurance are at higher risk of subsequent ED visits and hospitalization. These findings will inform targeted interventions to prevent hospitalization in this patient population.
由专科医生管理的重度持续性哮喘儿童是一个独特的患者群体。导致这些儿童住院的因素尚不清楚。本研究旨在确定该群体中与未来急诊就诊和住院相关的因素。
对2021年1月1日至2022年6月30日期间由肺科医生评估的重度持续性哮喘儿童进行病历审查。从电子病历中记录与哮喘相关的急诊就诊和住院情况。采用卡方检验、混合效应模型和逻辑回归分析患者特征与住院之间的关联。二次分析评估导致急诊就诊的因素。
我们确定了244例独特患者，共进行了487次肺部门诊就诊。其中，56%为黑人，58%有公共保险，32%有因哮喘入住重症监护病房的病史。在门诊就诊后的12个月内，84例（34%）患者有急诊就诊，46例（19%）至少有一次住院。二手烟暴露（比值比2.74，95%置信区间1.16 - 6.45）、公共保险（比值比3.37，95%置信区间1.46 - 7.82）和既往入住重症监护病房（比值比2.29，95%置信区间1.09 - 4.79）与哮喘加重住院呈正相关。在住院患者中，支气管肺发育不良（BPD）和胃食管反流病（GERD）与入院时间缩短有关。
尽管接受了专科护理，但暴露于香烟烟雾、既往入住重症监护病房或有公共保险的重度持续性哮喘儿童随后急诊就诊和住院的风险更高。这些发现将为预防该患者群体住院的针对性干预措施提供依据。
