Alexandra Kain, Frank H. Netter MD School of Medicine at Quinnipiac University, Hamden, CT, United States; Ricardo A. Aguilar, CHOC Children's Hospital of Orange County, Orange, CA, United States; Theodore Heyming, CHOC Children's Hospital of Orange County, Orange, CA, United States; Chloe Knudsen-Robbins, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Sunil Kamath, CHOC Children's Hospital of Orange County, Orange, CA, United States; Louis Ehwerhemuepha, CHOC Children's Hospital of Orange County, Orange, CA, United States; Peyman Hosseinzadeh Kassani, CHOC Children's Hospital of Orange County, Lake Forest, CA, United States
Medical Student Frank H. Netter MD School of Medicine at Quinnipiac University Hamden, Connecticut, United States
Background: Asthma, the most common chronic disease of childhood, can affect a child’s physical and mental health as well as their social and emotional well-being and development. More than half of children with asthma will experience at least one exacerbation each year. Objective: The aim of this study was to identify risk factors associated with Emergency Department (ED) return visits for asthma exacerbations. Design/Methods: This was a retrospective review of data from Cerner Real-World Data for patients 5-18 years seen at an ED for an asthma exacerbation 1/2016-12/2019 and discharged home at the index ED visit. Asthma visits were defined as encounters where a patient was diagnosed with asthma and a beta agonist, anticholinergic, or systemic steroid was ordered or prescribed at that encounter. A return visit was defined as an ED visit for asthma within 14 days of the index visit. Data regarding demographics, triage vital signs, asthma medications ordered during the visit, discharge oxygen saturation, ED length of stay, concomitant diagnosis of pneumonia, prior year healthcare utilization/prescriptions, medical diagnoses/comorbidity history, and complex chronic conditions, was collected. Data was analyzed via a logistic regression mixed effects model. Results: A total of 97,877 ED visits were included, 80,434 index visits and 17,443 return visits. Past year ED return visits were associated with a significantly increased odds ratio (OR) of a return visit (OR 2.12; CI 2.07, 2.17). The number of past year asthma related ED visits was associated with decreased odds of a return visit (OR 0.89; CI 0.87, 0.90). History of pneumonia and malignancy were associated with increased odds of a return visit (OR 1.20; CI 1.11, 1.29; OR 1.87; CI 1.19, 2.94). A concomitant diagnosis of pneumonia (OR 1.16; CI 1.04, 1.29), fever at triage (OR 1.12; CI 1.05, 1.19), and private health insurance (OR 1.19; CI 1.12, 1.27) were associated with increased odds of a return visit.
Conclusion(s): Several variables appear to be associated with statistically significant increased odds of ED return visits, ranging from healthcare utilization and historical variables, to triage vital signs and concurrent illness, to demographics. These findings, while not sufficient to propose changes in management, may prompt additional discussion/consideration during discharge planning for a subset of patients at increased risk of revisits.
