Asthma-related hospitalizations following critical asthma in children: A comparison between Canada and the United States.

Abstract

Children admitted to the intensive care unit (ICU) for asthma are at higher risk of future morbidity and mortality. Although Canada and the United States (US) may have different population compositions, studies have documented that up to 34% of American children hospitalized for asthma require ICU admission, compared to 4.5% in Canada. However, whether there are differences in the post-ICU asthma-related morbidity between the two countries is not known. This study compared the post-ICU asthma-related readmissions and ICU readmissions in children with critical asthma between Canada and the US. In this retrospective cohort study, we included children aged 2-17 years with an ICU admission for asthma in a pan-Canadian database (2008-2014) and a 4-state American database (2005-2014). The time to the first asthma-related readmission, the distribution of asthma-related readmissions within 1 year, and the proportion of ICU readmissions within 1 year were compared between the 2 countries. 1055 Canadian and 9377 American children were admitted to the ICU for asthma during the study period. The time to asthma-related readmission (p=0.29) and the frequency of asthma-related readmissions within 1 year (p=0.73) did not differ between Canada and the US. However, the proportion of children readmitted to the ICU for asthma within 1 year was significantly higher in the US (US: 40.1%, Canada: 28.9%; p=0.02). While the overall asthma-related readmissions in children with critical asthma did not differ between Canada and the US, a greater proportion of children were readmitted to the ICU in the US. Future studies should elucidate the causes underlying this difference.