A cost-saving algorithm for children hospitalized for status asthmaticus

Arch Pediatr Adolesc Med. 1998 Oct;152(10):977-84. doi: 10.1001/archpedi.152.10.977.


Objective: To test the ability of an assessment-driven algorithm for treatment of pediatric status asthmaticus to reduce length and cost of hospitalization.

Design: Nonrandomized, prospective, controlled trial.

Setting: Tertiary care children's hospital.

Patients: Children aged 1 to 18 years hospitalized for status asthmaticus; 104 were treated using the asthma care algorithm (intervention) and 97 using unstructured standard treatment (control).

Intervention: Patients were treated using either an assessment-based algorithm or standard care practices. The algorithm group was treated with standard medications (aerosolized albuterol, systemic corticosteroids, epinephrine, ipratropium) administered at a frequency driven by the patient's clinical condition. Specific criteria were outlined for decreasing or augmenting therapy, transferring to intensive care, and discharging to home. A unique patient record containing assessments, algorithm cues, and a treatment record was used. Intervention group patients were interviewed by telephone 1 week after discharge.

Main outcome measures: Hospital length of stay, cost per hospitalization, relapse rate, protocol adherence.

Results: Average hospital stay for intervention patients was significantly shorter than for control patients (2.0 vs 2.9 days, P<.001). Although intervention patients received fewer aerosolized albuterol doses than controls, there was no difference in short-term relapse rate between groups. The intervention saved more than $700 per patient in hospital charges. Adherence to the protocol was excellent, with only 8 variances per patient stay out of more than 150 opportunities.

Conclusion: An intensive, assessment-driven algorithm for pediatric status asthmaticus significantly reduces hospital length of stay and costs without increasing morbidity.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial

MeSH terms

  • Adolescent
  • Algorithms*
  • Child
  • Child, Preschool
  • Clinical Protocols
  • Cost Savings
  • Female
  • Hospital Charges / statistics & numerical data
  • Hospital Costs / statistics & numerical data
  • Hospitals, Pediatric / economics*
  • Humans
  • Infant
  • Length of Stay / economics*
  • Male
  • Ohio / epidemiology
  • Prospective Studies
  • Recurrence
  • Severity of Illness Index
  • Status Asthmaticus / economics*
  • Status Asthmaticus / epidemiology
  • Status Asthmaticus / therapy