30 - Characteristics and Management of Children with Acute Asthma Exacerbations in United States Pediatric Emergency Departments
Friday, April 28, 2023
5:15 PM – 7:15 PM ET
Poster Number: 30 Publication Number: 30.111
Melisa S.. Tanverdi, University of Colorado School of Medicine, Denver, CO, United States; Isabella Zaniletti, Children's Hospital Association, Tampa, FL, United States; Nidhya Navanandan, University of Colorado School of Medicine, Aurora, CO, United States; Isabel J. Hardee, University of Colorado School of Medicine, Denver, CO, United States; Andrew H. Liu, Children's Hospital Colorado, Aurora, CO, United States; Rakesh D.. Mistry, Children's Hospital Colorado, Aurora, CO, United States
Assistant Professor University of Colorado School of Medicine University of Colorado School of Medicine Aurora, Colorado, United States
Background: Asthma is the most prevalent pediatric chronic illness and a leading cause of emergency department (ED) visits, hospitalizations, and healthcare spending. Characteristics and management of children presenting to the ED for acute asthma exacerbations have not been recently characterized. Objective: To determine the demographics, clinical characteristics, and management of children presenting to the pediatric ED for acute asthma exacerbations. Design/Methods: Multicenter retrospective cohort study of children 2 to 18 years presenting for an acute asthma exacerbation to a pediatric ED contributing data to the Pediatric Hospital Information System (PHIS) database between 2015 and 2020. For inclusion, children must have had an ICD-9/10 code for asthma exacerbation and received albuterol during their ED visit. Patient demographics, Child Opportunity Index (COI, a geocoded composite measure of neighborhood resources and risk), ancillary testing, medications administered, respiratory support required, disposition, and adjusted cost were evaluated. Results: During the study period, a total 384,345 ED visits were made by 240,602 unique children from the 47 participating hospitals; 50,775 (21.1%) of patients had >1 ED visit within a 12-month time frame. Children had a median age of 6 years, 61.6% were male, 46.3% were African American, 23.7% were Hispanic, and 68.9% had public insurance. Children with COI of low or very low accounted for over half (61.8%) of visits. Most visits (59.1%) occurred during fall and winter months. In the ED, most children (71.8%) received nebulized ipratropium. Corticosteroids were prescribed for 89.3%, with dexamethasone prescribed most frequently (58.4%). The most common adjunctive pharmacologic agent was intravenous magnesium (15.4%); parenteral β-agonists were used in 1% of visits. Non-invasive ventilation was used in 1.9%. Most (71.7%) encounters resulted in a disposition of discharge from the ED, however 4.3% required intensive care. Diagnostic tests ordered during ED visits included respiratory viral testing (9.6%) and chest radiographs (22.5%) (Table). The median cost of asthma ED visits was $881; total costs were estimated at $200 million annually.
Conclusion(s): This multicenter study provides an updated characterization of acute asthma exacerbations in the pediatric ED and demonstrates increased use of dexamethasone and reduced ancillary testing. ED visits remain frequent and disproportionately affect children with lower social determinants of health.
