Pediatric Asthma Hospitalizations Research Articles

Neighborhood Risk and Hospital Use for Pediatric Asthma, Rhode Island, 2005-2014.

IntroductionStudies consistently show that children living in poor neighborhoods have worse asthma outcomes. The objective of our study was to assess the association between negative neighborhood factors (ie, neighborhood risk) and pediatric asthma hospital use. MethodsThis retrospective study used data from children aged 2 to 17 years in a statewide (Rhode Island) hospital network administrative database linked to US Census Bureau data. We defined an asthma visit as an International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code of 493 in any diagnosis field. We used 8 highly correlated measures for each census-block group to construct an index of neighborhood risk. We used maps and linear regression to assess the association of neighborhood risk with average annual census-block–group rates of asthma emergency department visits and hospitalizations. We used multivariable analyses to identify child characteristics and neighborhood risk associated with an asthma revisit, accounting for the child’s sociodemographic information, season, and multiple measurements per child.ResultsFrom 2005 through 2014, we counted 359,195 visits for 146,889 children. Of these, 12,699 children (8.6%) had one or more asthma visits. Linear regression results showed 1.18 (95% confidence interval, 1.06–1.30) more average annual emergency departments visits per 100 children and 0.41 (95% confidence interval, 0.34–0.47) more average annual hospitalizations per 100 children in neighborhoods in the highest-risk index quintile than in neighborhoods in the lowest-risk index quintile. ConclusionInterventions to improve asthma outcomes among children should move beyond primary care or clinic settings and involve a careful evaluation of social context and environmental triggers.

Reducing pediatric asthma hospital length of stay through evidence-based quality improvement and deployment of computerized provider order entry

Objective: Evaluate the impact of multi-component quality improvement for pediatric asthma care focusing on serial use of an evidence-based clinical pathway via paper order sets, pathway integration into computerized provider order entry (CPOE), use of a clinical respiratory score (CRS) and a discharge checklist. Methods: Outcomes were assessed over three intervention periods and 50 months on: time to beta-agonist and steroid first administration, frequency of readmissions and hospital length of stay. A general linear model estimated mean log(LOS) over time and between study periods. Time to discharge was transformed using the natural logarithm. Results: No improvements in time to first beta-agonist or steroid administration were observed. There was a reduction in 100-day readmissions (p = 0.008): decreasing from 7.4 to 2.1% after introduction of paper order sets and CRS (adjusted p = 0.04); to 3.9% after CPOE implementation (adjusted p = 0.53) and to 2.2% when a discharge checklist was added (adjusted p = 0.01). There was a statistically significant reduction in LOS between study periods (p = 0.015). The geometric mean LOS in hours during study periods 1–4 were: 34.8 (95% CI: 32.2, 37.6), 29.3 (95% CI: 27.5, 31.3), 29.0 (95% CI: 27.0, 31.3) and 23.1 (95% CI: 22.1, 24.2). Pair-wise comparisons between periods were statistically significant (adjusted p ≤ 0.003), except for Periods 2 and 3 (adjusted p = 0.83). Conclusions: Hospital length of stay and 100-day readmissions rate in a predominantly Hispanic, Medicaid patient population were reduced by utilization of an evidence-based best practices asthma management pathway and CRS within CPOE, combined with a checklist to expedite discharge.

Shale Gas Development, Natural Gas Flaring, and Pediatric Asthma Hospitalizations from 2000 to 2010 in Texas, U.S.A.

Background: Current estimates indicate that 4.5 million Texans live within 1 mile of at least one shale gas development (SGD) site, yet the respiratory health effects of residing near this industry remain unclear. SGD activities are associated with decreased air quality, including known respiratory irritants. This study aims to quantify the association between specific SGD activities and pediatric asthma hospitalizations in Texas.Methods: We leverage a 32 million record database of Texas inpatient hospitalizations to examine the association between natural gas development and pediatric respiratory hospitalizations via multilevel logistic models. In contrast to previous studies, we implement a quasi-experimental design to account for pre-existing spatiotemporal asthma hospitalization trends. We then use a database of monthly production reports to assess the heterogeneity of impact from drilling-specific exposures including drilling type and gas flaring activities.Results: We find that any drilling yields odds ratios ranging from 1.13 (95% CI: 0.99, 1.30) to 1.86 (95% CI: 1.57, 2.22) depending on age groups. Our results demonstrate that conventional drilling (OR: 2.02; 95% CI: 1.69, 2.41) may yield a higher risk for pediatric asthma hospitalizations than unconventional drilling (OR: 1.63; 95% CI: 1.33, 2.00). Additionally, flaring activities are consistently associated with pediatric asthma hospitalizations across multiple age groups, ranging from 1.09 (95% CI: 0.96, 1.22) to 1.54 (95% CI: 1.32, 1.78). These results hold across multiple sensitivity analyses.Conclusion: Pediatric asthma hospitalizations are increased with SGD and are similarly affected by conventional and unconventional drilling. Flaring may be a potential pathway for this association.

Impact of Obesity on Asthma Morbidity During a Hospitalization.

Asthma and obesity are 2 common pediatric problems. Obesity is a known risk factor for asthma, and obese children with asthma have higher disease burden. However, little is known on how obesity in urban minority children, mainly Hispanic and African American children, impacts morbidity during pediatric asthma hospitalizations. A retrospective chart review was conducted on children and adolescents age 2 to 18 years hospitalized at the Children's Hospital at Montefiore for an acute asthma exacerbation. We elucidated the association of overweight or obese status with severity of the exacerbation, quantified by length of stay (LOS) and need for intensive care management. Multivariate analysis was conducted to identify independent predictors of LOS. A total of 975 children met the inclusion criteria, of whom 55% were normal weight and 45% were overweight or obese. Sixty percent were Hispanic, and 37% were African American. The overall average LOS was 2.57 days (range: 0.67-12.92). Overweight or obese status was associated with a higher asthma severity at baseline (P = .021). Overweight or obese children had a longer average LOS compared with normal weight children (2.75 vs 2.39 days; P < .01) with more PICU stays (P = .006), even after adjustment for higher baseline asthma severity. The severity of the exacerbation did not differ by ethnicity. Obesity in children hospitalized for asthma is associated with more severe asthma exacerbations, longer LOS, and increased use of PICU level care, independent of their higher baseline disease severity and ethnicity.

Improving allergy office scheduling increases patient follow up and reduces asthma readmission after pediatric asthma hospitalization

BackgroundPediatric asthma is a major contributor to emergency room utilization and hospital readmission rates. ObjectiveTo develop an allergy department‒based intervention to improve follow-up appointment scheduling processes for pediatric asthma patients after discharge for asthma exacerbation. MethodsThis quality improvement study was conducted in the allergy clinic of an urban, tertiary children's hospital. Children receiving subspecialty allergy care for asthma were included into the intervention group during the intervention period. The quality improvement intervention consisted of 3 attempts by telephone to reach the family to schedule the follow-up appointment. If this was unsuccessful or if the appointment was not kept, then a reminder letter was sent to the family. The primary outcome of interest in this study was the percent of postdischarge follow-up appointments scheduled within 30 days of discharge. Secondary outcomes measured were the percent of allergy appointments attended within 30 days of discharge and the 30-day hospital readmission rate. ResultsDemographics did not differ significantly between the intervention and baseline preintervention year. The initial baseline scheduled allergy follow-up visit rate was 48.8 ± 13.3% of patients discharged per month. This increased to an overall rate of 75.7 ± 20.1% patients scheduling allergy follow-up within 30 days of discharge during the intervention year. We also observed a significant increase in attended allergy visits 30 days postdischarge from 35.5 ± 15.6% in year 1 to 53.9 ± 25.5% during the intervention year and a significant decrease in the 30-day readmission rate on the allergy service. ConclusionThese data suggests that minor changes in allergy practice organization can significantly affect posthospitalization follow-up rates and decrease asthma readmission rates.

Unconventional natural gas development and pediatric asthma hospitalizations in Pennsylvania

BackgroundPediatric asthma is a common chronic condition that can be exacerbated by environmental exposures, and unconventional natural gas development (UNGD) has been associated with decreased community air quality. This study aims to quantify the association between UNGD and pediatric asthma hospitalizations. MethodsWe compare pediatric asthma hospitalizations among zip codes with and without exposure to UNGD between 2003 and 2014 using a difference-in-differences panel analysis. Our UNGD exposure metrics include cumulative and contemporaneous drilling as well as reported air emissions by site. ResultsWe observed consistently elevated odds of hospitalizations in the top tertile of pediatric patients exposed to unconventional drilling compared with their unexposed peers. During the same quarter a well was drilled, we find a 25% increase (95% CI: 1.07, 1.47) in the odds of being hospitalized for asthma. Ever-establishment of an UNGD well within a zip code was associated with a 1.19 (95% CI: 1.04, 1.36) increased odds of a pediatric asthma hospitalization. Our results further demonstrate that increasing specific air emissions from UNGD sites are associated with increased risks of pediatric asthma hospitalizations (e.g. 2,2,4-trimethylpentane, formaldehyde, x-hexane). These results hold across multiple age groups and sensitivity analyses. ConclusionsCommunity-level UNGD exposure metrics were associated with increased odds of pediatric asthma-related hospitalization among young children and adolescents. This study provides evidence that additional regulations may be necessary to protect children's respiratory health from UNGD activities.

Impact of Discharge Components on Readmission Rates for Children Hospitalized with Asthma

To describe hospital-based asthma-specific discharge components at children's hospitals and determine the association of these discharge components with pediatric asthma readmission rates. This is a multicenter retrospective cohort study of pediatric asthma hospitalizations in 2015 at children's hospitals participating in the Pediatric Health Information System. Children ages 5 to 17 years were included. An electronic survey assessing 13 asthma-specific discharge components was sent to quality leaders at all 49 hospitals. Correlations of combinations of asthma-specific discharge components and adjusted readmission rates were calculated. The survey response rate was 92% (45 of 49 hospitals). Thirty-day and 3-month adjusted readmission rates varied across hospitals, ranging from 1.9% to 3.9% for 30-day readmissions and 5.7% to 9.1% for 3-month readmissions. No individual or combination discharge components were associated with lower 30-day adjusted readmission rates. The only single-component significantly associated with a lower rate of readmission at 3 months was having comprehensive content of education (P < .029). Increasing intensity of discharge components in bundles was associated with reduced adjusted 3-month readmission rates, but this did not reach statistical significance. This was seen in a 2-discharge component bundle including content of education and communication with the primary medical doctor, as well as a 3-discharge component bundle, which included content of education, medications in-hand, and home-based environmental mitigation. Children's hospitals demonstrate a range of asthma-specific discharge components. Although we found no significant associations for specific hospital-level discharge components and asthma readmission rates at 30 days, certain combinations of discharge components may support hospitals to reduce healthcare utilization at 3 months.

Health care access, concentrated poverty, and pediatric asthma hospital care use in California's San Joaquin Valley: A multilevel approach

ABSTRACTBackground: California's San Joaquin Valley is a region with a history of poverty, low health care access, and high rates of pediatric asthma. It is important to understand the potential barriers to care that challenge vulnerable populations. Objective: The objective was to describe pediatric asthma-related utilization patterns in the emergency department (ED) and hospital by insurance coverage as well as to identify contributing individual-level indicators (age, sex, race/ethnicity, and insurance coverage) and neighborhood-level indicators of health care access. Methods: This was a retrospective study based on secondary data from California hospital and ED records 2007–2012. Children who used services for asthma-related conditions, were aged 0–14 years, Hispanic or non-Hispanic white, and resided in the San Joaquin Valley were included in the analysis. Poisson multilevel modeling was used to control for individual- and neighborhood-level factors. Results: The effect of insurance coverage on asthma ED visits and hospitalizations was modified by the neighborhood-level percentage of concentrated poverty (RR = 1.01, 95% CI = 1.01–1.02; RR = 1.03, 95% CI = 1.02–1.04, respectively). The effect of insurance coverage on asthma hospitalizations was completely explained by the neighborhood-level percentage of concentrated poverty. Conclusions: Observed effects of insurance coverage on hospital care use were significantly modified by neighborhood-level measures of health care access and concentrated poverty. This suggests not only an overall greater risk for poor children on Medi-Cal, but also a greater vulnerability or response to neighborhood social factors such as socioeconomic status, community cohesiveness, crime, and racial/ethnic segregation.

The Child Opportunity Index and Disparities in Pediatric Asthma Hospitalizations Across One Ohio Metropolitan Area, 2011-2013

To determine whether the Child Opportunity Index (COI), a nationally available measure of relative educational, health/environmental, and social/economic opportunity across census tracts within metropolitan areas, is associated with population- and patient-level asthma morbidity. This population-based retrospective cohort study was conducted between 2011 and 2013 in a southwest Ohio county. Participants included all children aged 1-16 years with hospitalizations or emergency department visits for asthma or wheezing at a major pediatric hospital. Patients were identified using discharge diagnosis codes and geocoded to their home census tract. The primary population-level outcome was census tract asthma hospitalization rate. The primary patient-level outcome was rehospitalization within 12 months of the index hospitalization. Census tract opportunity was characterized using the COI and its educational, health/environmental, and social/economic domains. Across 222 in-county census tracts, there were 2539 geocoded hospitalizations. The median asthma-related hospitalization rate was 5.0 per 1000 children per year (IQR, 1.9-8.9). Median hospitalization rates in very low, low, moderate, high, and very high opportunity tracts were 9.1, 7.6, 4.6, 2.1, and 1.8 per 1000, respectively (P < .0001). The social/economic domain had the most variables significantly associated with the outcome at the population level. The adjusted patient-level analyses showed that the COI was not significantly associated with a patient's risk of rehospitalization within 12 months. The COI was associated with population-level asthma morbidity. The details provided by the COI may inform interventions aimed at increasing opportunity and reducing morbidity across regions.

Impact of respiratory infections, outdoor pollen, and socioeconomic status on associations between air pollutants and pediatric asthma hospital admissions.

BackgroundEpidemiology studies have shown that ambient concentrations of ozone and fine particulate matter (PM2.5) are associated with increased emergency department (ED) visits and hospital admissions (HAs) for asthma.ObjectiveEvaluate the impact of outdoor pollen, respiratory infections, and socioeconomic status (SES) on the associations between ambient ozone and PM2.5 and asthma HAs in New York City.MethodsDaily ozone, PM2.5, meteorological factors, pollen, and hospitalization records during 1999 to 2009 were obtained for New York City residents. Daily counts of HAs for asthma and respiratory infections were calculated for all-age and specific age groups, and for high- and low-SES communities. Generalized additive models were used to examine ambient concentrations of ozone and PM2.5 and asthma HAs, potential confounding effects of outdoor pollen and HAs for respiratory infections, and potential effect modification by neighborhood SES.ResultsBoth ozone and PM2.5 were statistically significantly associated with increased asthma HAs in children aged 6–18 years (per 10 ppb increase in ozone: RR = 1.0203, 95% CI: 1.0028–1.0382; per 10 μg/m3 increase in PM2.5: RR = 1.0218, 95% CI: 1.0007–1.0434), but not with total asthma HAs, or asthma HAs in other age groups. These associations were stronger for children living in the high-SES areas. Adjustment for respiratory infection HAs at various lags did not result in changes greater than 10% in the risk estimates for either ozone or PM2.5. In contrast, adjustment for outdoor pollen generally attenuated the estimated RRs for both ozone and PM2.5.ConclusionsAmbient ozone and PM2.5 are associated with asthma HAs in school-age children, and these associations are not modified by SES. HAs for respiratory infections do not appear to be a confounder for observed ozone- and PM2.5-asthma HAs associations, but pollen may be a weak confounder.

“Spike” in acute asthma exacerbations during enterovirus D68 epidemic in Japan: A nation-wide survey

BackgroundIn September 2015, Japan experienced an unusual increase in acute asthma hospitalizations of children that coincided with an enterovirus D68 (EV-D68) epidemic. The objective of this study is to investigate whether EV-D68 had a causal relationship with the spike in asthma hospitalizations. MethodsA nation-wide retrospective survey of asthma hospitalizations of children was performed for the period from January 2010 through October 2015. The Japanese Society of Pediatric Allergy and Clinical Immunology asked its affiliated hospitals to report monthly numbers of hospitalizations, ICU admissions and mechanical ventilations due to acute asthma exacerbation. The data were retrieved from medical databases using predefined search criteria: diagnosis of asthma or asthmatic bronchitis, admission, and age <20 years. Monthly numbers of EV-D68 detection were also obtained from the Infectious Disease Surveillance Center of Japan. A Granger causality test was used to analyze the association of EV-D68 detections for asthma exacerbation. ResultsA total of 157 hospitals reported 87,189 asthma hospitalizations, including 477 ICU admissions and 1193 mechanical ventilations, during the survey period of 5 years and 10 months. The numbers of these events increased drastically in September 2015. The Granger causality test verified the association between EV-D68 and asthma hospitalizations/mechanical ventilations. The most-affected age group was 3–6 years old. ConclusionsThe spike in pediatric asthma hospitalizations in Japan in September 2015 was found to be associated with the EV-D68 epidemic. Respiratory pathogens can cause “epidemics” of asthma exacerbation. Coordinated surveillance of infectious diseases and asthma may be beneficial for prevention and better control of both illnesses.

Pediatric asthma hospitalizations among urban minority children and the continuity of primary care

ABSTRACTObjective: To examine the effect of ambulatory health care processes on asthma hospitalizations. Methods: A retrospective cohort study using electronic health records was completed. Patients aged 2–18 years receiving health care from 1 of 5 urban practices between Jan 1, 2004 and Dec 31, 2008 with asthma documented on their problem list were included. Independent variables were modifiable health care processes in the primary care setting: (1) use of asthma controller medications; (2) regular assessment of asthma symptoms; (3) use of spirometry; (4) provision of individualized asthma care plans; (5) timely influenza vaccination; (6) access to primary healthcare; and (7) use of pay for performance physician incentives. Occurrence of one or more asthma hospitalizations was the primary outcome of interest. We used a log linear model (Poisson regression) to model the association between the factors of interest and number of asthma hospitalizations. Results: 5,712 children with asthma were available for analysis. 96% of the children were African American. The overall hospitalization rate was 64 per 1,000 children per year. None of the commonly used asthma-specific indicators of high quality care were associated with fewer asthma hospitalizations. Children with documented asthma who experienced a lack of primary health care (no more than one outpatient visit at their primary care location in the 2 years preceding hospitalization) were at higher risk of hospitalization compared to those children with a greater number of visits (incidence rate ratio 1.39; 95% CI 1.09–1.78). Conclusions: In children with asthma, more frequent primary care visits are associated with reduced asthma hospitalizations.

Comparison of treatment modalities for inpatient asthma exacerbations among US pediatric hospitals

When comparing treatment for inpatient pediatric asthma hospitalizations, there is significant variability in treatment with magnesium sulfate, ipratropium bromide, terbutaline, heliox, BiPAP, and mechanical ventilation for PICU admissions across U.S. pediatric hospitals.

A Comprehensive Pediatric Asthma Management Program Reduces Emergency Department Visits and Hospitalizations

We evaluated the impact of a comprehensive pediatric asthma management program (the Children's Asthma Wellness Program, CAWP) on the frequency of emergency department (ED) visits and hospital admissions. The CAWP generally consisted of 4 clinic sessions over a 1-year period, but some patients attended fewer clinic sessions, and some required additional clinic sessions due to incomplete asthma control. Patients were evaluated and treated by pediatric pulmonologists, nurse asthma care coordinator/educator, and social worker. We retrospectively reviewed program results over an 8-year period (2005–2013). We compared ED visits and hospital admissions before and after participation in the CAWP. There were 254 children referred to the CAWP; 172 children were enrolled. Fifty-four children (31%) received >6 sessions due to incomplete asthma control. On average, children requiring additional clinic sessions were older and more likely to be African American, hold Medicaid insurance, and have severe asthma. We obtain...

Disparities in Mortality and Morbidity in Pediatric Asthma Hospitalizations, 2007 to 2011

ObjectiveAsthma is a leading cause of pediatric admissions. Although several factors including race have been linked to increased overall asthma morbidity and mortality, few studies have explored factors associated with inpatient asthma outcomes. We examined factors associated with mortality and morbidity in children admitted for asthma. MethodsData were obtained from the US Nationwide Inpatient Sample for 2007 to 2011. Patients 2 to 18 years old with a primary diagnosis of asthma were included. Predictor variables were sociodemographic and hospital factors and acute/chronic secondary diagnoses. Outcomes were mortality, intubation, length of stay (LOS), and costs. Weighted national estimates were calculated. Multivariable analyses were performed. ResultsThere were 97,379 (478,546 weighted) asthma admissions. Most patients were male (60.6%); 30% were white, 28% black, and 18% Hispanic. Mortality rate was 0.03%, and 0.3% were intubated. Median LOS was 2 (interquartile range, 1–3) days. Median costs were $2,950 (interquartile range, $1990–$4610). Native American race, older age (13–18 years), and West region were significant independent predictors of mortality. Intubation rate was lower in Hispanic compared with white children (P = .028). LOS was shorter in Asian compared with white children (P = .022) but longer in children with public insurance and from low income areas (P < .001). Average costs were higher in black, Hispanic, and Asian compared with white children (P < .05). ConclusionsWith the exception of Native Americans, race/ethnicity is not associated with inpatient asthma mortality and has varied effects on morbidity. Recognition of factors associated with increased asthma mortality and morbidity might allow for earlier, more effective treatment and avoidance of complications.

Forecasting Emergency Paediatric Asthma Hospital Admissions in Trinidad and Tobago: Development of a Local Model Incorporating the Interactions of Airborne Dust and Pollen Concentrations with Meteorological Parameters and a Time-Lag Factor

Respiratory diseases such as asthma and rhinitis are multifaceted disorders which are exacerbated by various factors including: gender, age, diet, genetic background, biological materials, allergens (pollen and spores), pollutants, meteorological conditions and dust particles. It is hypothesized that, the number of valid physician diagnosed cases of paediatric asthma, which has resulted in emergency room visits in Trinidad can be expressed as a function of the magnitude of pollen counts, particulate matter (PM10), and selected meteorological parameters. These parameters were used to develop a 7-day predictive model for paediatric asthma admittance. The data showed no obvious, strong correlations between paediatric asthma admissions and dust concentrations, and paediatric asthma admissions and pollen concentrations, when considered in isolation or in a linear fashion. However, using polynomial regression analysis, which looked at combinations of interactions, a strong 7-day predictive model for paediatric asthma admissions, was developed. The model was tested against actual data collated during the study period and showed a strong correlation (R2 = 0.85) between the regression model and the actual admissions data.

Childhood Asthma Hospital Discharge Medication Fills and Risk of Subsequent Readmission

ML Kenyon, DM Rubin, JJ Zorc, Z Mohamad, JA Faerber, C Feudtner. J Pediatr. 2015;166(5):1121–1127 This study assessed the relationship between prescription fills for asthma medications after pediatric asthma hospital discharge and subsequent hospital readmission. Patients between the ages of 2 and 18 years with claims for inpatient hospitalizations for asthma from January 1, 2006, to September 30, 2007, were included. Patients were excluded if aged <2 years, if they died during their index hospitalization, or were discharged to other care facilities. Retrospective cohort study of Medicaid claims data taken from 12 states from 2005 to 2007. The primary outcome of interest was time …

PRS11 - Comparison on Pediatric Asthma Hospital Admissions Through Emergency Department: Medicaid Vs Private Insurance

PRS11 - Comparison on Pediatric Asthma Hospital Admissions Through Emergency Department: Medicaid Vs Private Insurance

Meta-analysis of the relationship between particulate matter (PM(10) and PM(2.5)) and asthma hospital admissions in children

To systematically review and assess the relationship between particulate matter (PM(10) and PM(2.5)) and children's hospital admissions for asthma, using both time-series and case-crossover analyses. The PubMed, Ebsco, Ovid and four Chinese periodical databases were screened for studies related to short-term effects of particulate matter on pediatric asthma hospital admissions published from 1 January 1990 to 31 December 2013.Sixteen studies on PM(10) and 10 studies on PM(2.5) were selected finally for meta-analysis. Relative risk (RR) or odds ratio (OR) and 95% confidence intervals (CI) of asthma hospital admissions per 10 µg/m³ increase of daily particulate matter were obtained from each study. RevMan 5.2.11 was used to test the heterogeneity of the results among the different studies and amalgamat the effect size by fixed or random effect model. As the concentration of PM(10) increased per 10 µg/m³, the children's hospital admissions for asthma increased by 1.75%; for PM(2.5), a 3.45% increase for asthma hospital admissions as the concentration increased per 10 µg/m³. By subgroup analysis based on study design, the effect size on both PM(10) and PM(2.5) of case-crossover study's results were higher than time-series analysis. The short-term increase of the concentration of PM(10) and PM(2.5) may led to the increase of Children's hospital admissions for asthma, and PM(2.5) will present a higher risk contribution.

Factors associated with length of stay for pediatric asthma hospitalizations

Objective: Asthma is a leading cause of pediatric hospitalizations, but little is known about factors associated with length of stay (LOS) for asthma hospitalizations. The aim of this study was to identify factors associated with LOS for pediatric asthma hospitalizations. Methods: The Pediatric Health Information System (PHIS) was used to cohort patients 2–17 years old with a primary asthma diagnosis discharged from 42 PHIS hospitals in 2011. Sociodemographic, temporal and health-status factors were examined. Bivariate and generalized-estimating-equation logistic regression analyses were performed to identify factors associated with LOS, after adjusting for severity of illness (SOI). Results: In total, 25 900 children were hospitalized, with a mean LOS of 1.9 days. In bivariate analysis, mean LOS was longer (p < 0.01) for patients with complex chronic conditions (CCC) (3.1 days versus 1.8 for non-CCC) and adolescents (2.3 versus 1.8 for 2–5 years old). In multivariable analysis, obstructive sleep apnea (OSA; OR 2.3; 95% CI: 1.8–2.9), older age (OR 1.3; 95% CI: 1.2–1.4), obesity (OR 1.3; 95% CI: 1.1–1.4), CCC (OR 1.3; 95% CI: 1.1–1.4), winter admissions (OR 1.2; 95% CI: 1.1–1.4), female gender (OR 1.1; 95% CI: 1.1–1.3), and weekend admissions (OR 1.1; 95% CI: 1.03–1.2) had higher odds of asthma LOS >2 days. Conclusions: OSA, older age, obesity, CCC, winter and weekend admissions, and female gender are associated with longer LOS for pediatric asthma hospitalizations, after adjustment for SOI. The study findings suggest that interventions focused on these at-risk groups may prove most useful in reducing LOS for pediatric asthma hospitalizations.