Long-term asthma-related readmission in children previously admitted to the intensive care unit for asthma

Abstract

Introduction Childhood asthma is a significant public health problem in the United States, where more than 6 million children are affected by asthma. In 2011, a national survey showed that almost 611,000 Emergency Department visits and 200,000 hospital admissions annually among children are associated to asthma. There are no studies that have exhaustively described the characteristics of asthmatic pediatric patients admitted to ICUs and their long-term follow-up assessing the asthma-related readmissions. The objective of this study was to compare time to asthma-related readmission between children with a previous hospitalization for asthma requiring ICU admission and those with a non-ICU hospitalization in the United States. Methods State Inpatient Database for 4 states from 2005 to 2014 was used in a retrospective cohort study. Children aged 2–17 years were included. The index hospitalization was defined as a hospitalization with a primary diagnosis of asthma (ICD-9 code 493.XX). Time to asthma-related readmissions and the time to asthma-related ED visit that did not result in a hospitalization were recorded. The log-rank test was used to study differences in the time to readmission and ED visit between children who were admitted and those who were not admitted to the ICU during the index hospitalization. The Cox regression was used to evaluate the associated risk of some variables to the readmission, estimated by the calculation of the hazard ratio (HR) and its 95% of confidence interval. Results A total of 66,835 subjects were hospitalized. Fifteen percent of the hospitalizations required ICU admission. The mean (SD) age was 5.7 (3.8) years, with 60.5% being males. Children admitted to the ICU were older [7.1(4.3) and 6.4(4.1) years in the ICU and non-ICU groups]. A total of 12,844 children were readmitted for asthma during the study period while 22,915 had an asthma-related ED visit. The time to asthma-related readmission was lower in the ICU group compared to the non-ICU group (P Conclusion Children previously admitted to the ICU for asthma were at increased risk of asthma-related readmission, underlining the importance of the long-term follow-up of these children.