Acute Asthma Management in Children: Factors Identifying Patients at Risk for Intensive Care Unit Treatment

Abstract

The hospitalization and mortality rates incurred from childhood asthma continue to rise despite recent progress into the pathophysiology and treatment of reactive airway disease. We believe that there are specific factors that identify children at risk for death from asthma. The objective of the study was to determine those risk factors that identify children at increased risk for nonfatal, but life-threatening asthma exacerbations resulting in pedi-atric intensive care unit (PICU) admission. Patients aged 10 months-16 years admitted to Brenner Children's Hospital for status asthmaticus between April 1991 and December 1992 were evaluated with regard to the prevalence of eight different factors using two categories for asthma: (1) life-threatening asthma requiring PICU admission and (2) non-life-threatening asthma requiring routine hospitalization. Risk factors associated with an increased prevalence of non-fatal, but life-threatening asthma requiring PICU admission were female gender, lack of third-party insurance, and a severe grade of asthma using National Heart, Lung, and Blood Institute guidelines. There was no association with age, race, smoking exposure, time of the year, or family history of atopy. PICU admission for status asthmaticus was equally divided between girls and boys in terms of absolute numbers (17 and 19, respectively); however, 1 of every 3 female hospitalizations for asthma was to the PICU whereas in boys this figure was only 1 out of every 5 admissions. In addition, greater than 75% of the patients admitted to the PICU for asthma lacked private insurance coverage. More important, all severities of asthma and ages were represented by PICU admissions.