Abstract
BackgroundAsthma attacks are common and have significant physical, psychological, and financial consequences. Improving the assessment of a child's risk of subsequent asthma attacks could support front‐line clinicians’ decisions on augmenting chronic treatment or specialist referral. We aimed to identify predictors for emergency department (ED) or hospital readmission for asthma from the published literature.MethodsWe searched MEDLINE, EMBASE, AMED, PsycINFO, and CINAHL with no language, location, or time restrictions. We retrieved observational studies and randomized controlled trials (RCT) assessing factors (personal and family history, and biomarkers) associated with the risk of ED re‐attendance or hospital readmission for acute childhood asthma.ResultsThree RCTs and 33 observational studies were included, 31 from Anglophone countries and none from Asia or Africa. There was an unclear or high risk of bias in 14 of the studies, including 2 of the RCTs. Previous history of emergency or hospital admissions for asthma, younger age, African‐American ethnicity, and low socioeconomic status increased risk of subsequent ED and hospital readmissions for acute asthma. Female sex and concomitant allergic diseases also predicted hospital readmission.ConclusionDespite the global importance of this issue, there are relatively few high quality studies or studies from outside North America. Factors other than symptoms are associated with the risk of emergency re‐attendance for acute asthma among children. Further research is required to better quantify the risk of future attacks and to assess the role of commonly used biomarkers.
Highlights
Asthma is the most frequent chronic disease in children[1] and its worldwide prevalence is still rising, with an estimated 300 million people affected.[2]
A total of 3259 records were identified and screened for eligibility with one additional paper obtained through reference list screening (Figure 1)
Information on relevant aspects of the methods, mainly sample selection, or did not state clearly the number or factors studied in order to assess reporting bias
Summary
Asthma is the most frequent chronic disease in children[1] and its worldwide prevalence is still rising, with an estimated 300 million people affected.[2]. Asthma attacks are common[6] and are associated with high healthcare costs[7] as well as missed school and workdays They cause anxiety[8] and carry a risk of death and long-term effects such as loss of lung function.[9] These acute events are especially relevant for children among whom there is the greatest potential for loss of lung function. We retrieved observational studies and randomized controlled trials (RCT) assessing factors (personal and family history, and biomarkers) associated with the risk of ED re-attendance or hospital readmission for acute childhood asthma. There was an unclear or high risk of bias in 14 of the studies, including 2 of the RCTs. Previous history of emergency or hospital admissions for asthma, younger age, African-American ethnicity, and low socioeconomic status increased risk of subsequent ED and hospital readmissions for acute asthma. Further research is required to better quantify the risk of future attacks and to assess the role of commonly used biomarkers
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