Risk factors for repeat adverse asthma events in children after visiting an emergency department

Ambul Pediatr. Sep-Oct 2008;8(5):281-7. doi: 10.1016/j.ambp.2008.04.008. Epub 2008 Jun 27.

Abstract

Objective: The aim of this study was to identify risk factors for long-term adverse outcomes in children with asthma after visiting the emergency department (ED).

Methods: A prospective observational study was conducted at the ED of a pediatric tertiary hospital in Ontario, Canada. Patient outcomes (ie, acute asthma episodes and ED visits) were measured at baseline and at 1- and 6-months post-ED discharge. Time trends in outcomes were assessed using the generalized estimating equations method. Multiple conditional logistic regressions were used to model outcomes at 6 months and examine the impact of drug insurance coverage while adjusting for confounders.

Results: Of the 269 children recruited, 81.8% completed both follow-ups. ED use significantly reduced from 39.4% at baseline to 26.8% at 6 months (P < .001), whereas the level of acute asthma episodes remained unchanged. Children with drug insurance coverage were less likely to have acute asthma episodes (adjusted odds ratio [AOR] = 0.36; 95% CI, 0.15-0.85; P < .02) or repeat ED visits (AOR = 0.45; 95% CI, 0.20-0.99; P < .05) at 6 months. Other risk factors for adverse outcomes included previous adverse asthma events and certain asthma triggers (eg, cold/sinus infection). Washing bed linens in hot water weekly was protective against subsequent acute asthma episodes.

Conclusions: Our study demonstrated significant improvements in long-term outcomes in children seeking acute care for asthma in the ED. Future efforts remain in targeting the sustainability of improved outcomes beyond 6 months. Risk factors identified can help target vulnerable populations for proper interventions, which may include efforts to maximize insurance coverage for asthma medications and strategies to improve asthma self-management through patient and provider education.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Anti-Asthmatic Agents / economics
  • Anti-Asthmatic Agents / therapeutic use
  • Asthma / diagnosis*
  • Asthma / drug therapy
  • Asthma / epidemiology*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Confidence Intervals
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Follow-Up Studies
  • Hospitals, Pediatric
  • Humans
  • Insurance, Pharmaceutical Services / statistics & numerical data*
  • Logistic Models
  • Male
  • Odds Ratio
  • Ontario
  • Patient Compliance / statistics & numerical data
  • Prospective Studies
  • Recurrence
  • Respiratory Function Tests
  • Risk Factors
  • Severity of Illness Index
  • Socioeconomic Factors
  • Status Asthmaticus / diagnosis
  • Status Asthmaticus / drug therapy
  • Treatment Outcome
  • Urban Population

Substances

  • Anti-Asthmatic Agents