Management of asthma exacerbations in pediatric emergency departments across the United States.

IF 1.3 4区 医学 Q3 ALLERGY
Journal of Asthma Pub Date : 2025-10-01 Epub Date: 2025-06-04 DOI:10.1080/02770903.2025.2513056
Melisa S Tanverdi, Isabella Zaniletti, Nidhya Navanandan, Isabel Hardee, Andrew H Liu, Rakesh D Mistry
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引用次数: 0

Abstract

Objectives: There are 750,000 emergency department (ED) visits by children for asthma exacerbations in the United States annually. Despite changing evidence and epidemiology, there have not been recent assessments of acute asthma prevalence, management, and outcomes from pediatric EDs. This 40-center retrospective evaluation utilizes the Pediatric Hospital Information System to characterize pediatric ED asthma presentations from 2015-2020.

Study design: Children 2-18 years with asthma ICD-9/10 code and receipt of albuterol were included. Demographics, Child Opportunity Index (COI), ED management, return visits, and adjusted costs were evaluated. Data were summarized using standard descriptive statistics and trends assessed using Mann-Kendall trend test.

Results: There were 414,264 encounters made by 256,209 unique patients; 21% had >1 visit in 12 months. Median age was 6 years, 61.6% male, 44.5% Black, and 68.5% publicly insured; 58.3% of visits were by patients with very low/low COI. Systemic corticosteroids were administered in 86.3% of visits; 52.7% used dexamethasone. Chest radiographs were obtained in 23% of encounters. Most (74.9%) encounters resulted in ED discharge with a downward trend of visits for exacerbations per 1,000 ED visits of -9.77, 95% CI [-9.99,-9.54], increase in disposition to intensive care unit of 2.01 [1.87,2.41] and decrease in home/other of -3.77 [-4.34,-3.20]. There was no significant trend in return visits. Total adjusted costs were ∼$900 million.

Conclusions: ED visits for asthma remain frequent and disproportionately affect children with lower social determinants of health. Dexamethasone has not been widely adopted as corticosteroid of choice and use of ancillary testing continues, highlighting opportunities for improvement in asthma care.

全美儿科急诊科哮喘发作的管理
目的:在美国,每年有75万儿童因哮喘加重而到急诊室就诊。尽管证据和流行病学在不断变化,但最近还没有对儿科急诊科急性哮喘的患病率、管理和结局进行评估。这项40个中心的回顾性评估利用儿科医院信息系统来描述2015-2020年儿科ED哮喘的表现。研究设计:纳入2-18岁哮喘患儿ICD-9/10代码和沙丁胺醇接受情况。评估了人口统计学、儿童机会指数(COI)、ED管理、回访和调整后的成本。采用标准描述性统计对数据进行汇总,采用Mann-Kendall趋势检验对趋势进行评估。结果:256209例独特患者共就诊414264次;21%的网站在12个月内访问量达到100万次。中位年龄为6岁,男性61.6%,黑人44.5%,公共保险68.5%;58.3%的患者是非常低/低COI。86.3%的患者接受全身性皮质类固醇治疗;52.7%使用地塞米松。23%的患者接受胸片检查。大多数(74.9%)就诊导致急诊科出院,每1000次急诊科就诊的加重次数呈下降趋势,为-9.77,95% CI[-9.99,-9.54],重症监护病房的处置增加2.01[1.87,2.41],家庭/其他减少-3.77[-4.34,-3.20]。回访没有明显的趋势。调整后的总费用约为9亿美元。结论:因哮喘就诊的儿童仍然频繁,而且对健康社会决定因素较低的儿童的影响不成比例。地塞米松尚未被广泛采用作为皮质类固醇的选择,辅助检测的使用仍在继续,这突出了哮喘护理的改善机会。
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来源期刊
Journal of Asthma
Journal of Asthma 医学-过敏
CiteScore
4.00
自引率
5.30%
发文量
158
审稿时长
3-8 weeks
期刊介绍: Providing an authoritative open forum on asthma and related conditions, Journal of Asthma publishes clinical research around such topics as asthma management, critical and long-term care, preventative measures, environmental counselling, and patient education.
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