NATIONAL OUTCOMES OF STATUS ASTHMATICUS AMONG THE ELDERLY

Abstract

SESSION TITLE: Critical Care 2 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: Asthma is an unrecognized entity in the elderly with a prevalence of 13%. Acute asthma exacerbation (AAE) in this population presents a significant risk of morbidity and mortality. Status asthmaticus (SA) represents the most severe presentation of this disease, in which asthma attacks occur continuously without remission. Outcomes of AAE and SA in the elderly are not well studied. We sought to investigate the impact of SA among elderly patients in a large national dataset. METHODS: The National Inpatient Sample (NIS) was investigated for geriatric patients admitted with SA and AAE between 2009 and 2014. Demographic and clinical characteristics, including age, sex, race, income groups, comorbidity, and hospital types were compared between groups. We then compared across clinical outcomes of interest, including use of non-invasive mechanical ventilation (NIMV), invasive mechanical ventilation (IMV), prolonged IMV > 96 hours, in-hospital mortality and discharge to home. All estimates utilized appropriate complex survey methods, such that estimates were nationally representative. Significant differences between groups were tested using Rao-Scott Chi-Square. RESULTS: There were 475,770 weighted discharges for asthma exacerbation over the study period, of which 15,318 (3.2%) were SA. Overall, female sex (72.3%), was predominant in our cohort with multiple comorbidities (78.3%), and highest prevalence in the winter (29.3%) and spring (27.0%) months. Patients with SA tended to be slightly younger than those with AAE (AAE mean 75.9 y vs SA mean 74.7 y, p<0.0001) and had a longer length of stay (AAE mean 4.6 d vs SA 5.5 d, p<0.0001). Although there were similar rates of NIMV use (AAE 4.5% vs SA 5.4%, p = 0.05), there was a more than two-fold difference in the rate of IMV (AAE 1.5% vs SA 4.4%, p<0.0001). Despite this, among patient who did receive IMV, there were no significant differences in prolonged IMV >96 hours (AAE 34.3% of IMV vs SA 31.5% of IMV, p=0.52). Furthermore, though there were similar rates of in-hospital mortality in patients admitted with SA (AAE 0.9% vs SA 1.2%, p = 0.06), SA patients were significantly more likely to be discharged to home without services (AAE 65.9% vs SA 71.4%, p <0.0001). CONCLUSIONS: Patients admitted with SA were more likely to receive IMV than their AAE counterparts, yet were more frequently discharged home without services. SA in the elderly is associated with a high mortality and warrants aggressive interventions. Clinicians should be aware and have a low threshold for ventilator support when appropriate to avoid adverse clinical outcomes. CLINICAL IMPLICATIONS: There is need to keep a low threshold for ventilator support, NIMV or IMV in the elderly with SA. DISCLOSURES: No relevant relationships by Raymonde Jean, source=Web Response No relevant relationships by Raymond Jean, source=Web Response No relevant relationships by Sathish Pondaiah, source=Web Response No relevant relationships by Bertin Salguero, source=Web Response No relevant relationships by Fernando Vazquez de Lara, source=Web Response