Long-term asthma-related readmissions: comparison between children admitted and not admitted to the intensive care unit for critical asthma

Abstract

Objectives

To compare the time to asthma-related readmission between children admitted to the intensive care unit (ICU) for asthma and those with a non-ICU hospitalization in the United States and to explore risk factors associated with readmission among children admitted in the ICU.

Methods

In this retrospective cohort study, we included children aged 2–17 years in the State Inpatient Database (2005-2014) from four U.S. states who were hospitalized for asthma. We compared the time to asthma-related readmissions and emergency department (ED) visit between children admitted and not admitted to the ICU using the log-rank test. Among those admitted to the ICU, we explored factors associated with readmission using Cox regression.

Results

66 835 children were hospitalized for asthma, with 14.0% admitted to the ICU, and 12 844 were readmitted for asthma while 22 915 had an asthma-related ED visit. The time to asthma-related readmission was shorter in the ICU group compared to the non-ICU group (p < 0.001), but the time to asthma-related ED visit did not differ between the two groups (p = 0.43). Being preschool-aged, female, Black, and having lower household income and a longer length of stay during the initial hospitalization conferred a higher risk of asthma-related readmission among children admitted to the ICU. Preschool age and Medicaid were Florida-specific risk factors while Hispanic ethnicity was New York-specific.

Conclusion

Compared to children not admitted to the ICU, children admitted to the ICU for asthma were at increased risk of asthma-related readmission, with certain risk factors conferring an even higher risk.

Keywords:

• Pediatrics
• critical care
• risk factors
• morbidity

Acknowledgements

We thank Dr Mary E. Hartman (Washington University, St. Louis) for her assistance in obtaining the data for this study.

Declaration of interest

The authors have no conflicts of interest to declare.

Additional information

Funding

This study was supported by a grant from the Respiratory Health Network of the Fonds de recherche du Québec – Santé (FRQS). SMT is supported by a Clinical Research Scholar Bursary from the FRQS. IJ is supported by a post-doctoral fellowship grant from Canadian Francophonie Scholarship Program of the Government of Canada.