Variation in Triage to Pediatric vs Adult ICUs Among Adolescents and Young Adults With Asthma Exacerbations

Abstract

BackgroundOver 90,000 children and adults in the United States are hospitalized with an asthma exacerbation annually, and between 5-34% of these hospitalizations include an admission to an intensive care unit (ICU). It is unclear how adolescent and young adults with severe asthma exacerbations are triaged in the inpatient setting between pediatric (PICUs) and adult ICUs. Using a large multicenter United States cohort, we characterized how hospitals triage adolescents and young adults with asthma exacerbations between PICUs and adult ICUs. Research QuestionHow do hospitals across the United States triage adolescents and young adults with asthma exacerbations between PICUs and adult ICUs? Study Design and MethodsThis was a retrospective cohort study from 2016 to 2022 using the enhanced-claims PINC AI database. Participants were patients aged 12-26 hospitalized with asthma exacerbation and admitted to a PICU or adult ICU. We used nested hierarchical multivariable regression models to quantify changes in the intraclass correlation coefficient (a measure of variation in triage decisions attributable to hospital of admission after accounting for covariables). ResultsAnalyses included 3,946 admissions from 93 hospitals. Stratified by age, the percent of patients admitted to PICUs dropped by 26.9% between age 17 to age 18. In the nested models, the ICC had a large decrease going from the empty model (28.7%) to the age-adjusted model (4.5%) but was similar between the age-adjusted and fully adjusted model (3.4%). InterpretationAmong adolescents and young adults with asthma exacerbations, age ≤18 years was a strong determinant of PICU triage. Further research is needed to understand differences in asthma care and outcomes between PICUs and adult ICUs, as well as how intermediate care units affect triage decision-making from wards and the emergency department.