Pediatric asthma severity scores distinguish suitable inpatient level of care for children admitted for status asthmaticus

Abstract

Objective: To determine if the Pediatric Asthma Severity Score (PASS) can distinguish “late-rescues” (transfer to the pediatric intensive care unit [PICU] within 24-hours of general pediatric floor admission), “PICU readmissions” (readmission within 24-h after transfer to a lower inpatient level of care), and unplanned 30-day hospital readmission in children admitted with status asthmaticus.

Methods: We performed a single center, retrospective cohort study in 328 children admitted for asthma exacerbation aged 5–18 years from May 2015 to October 2017. We sought to determine if PASS values preceding admission from the emergency department or transfer to the general pediatric unit will be greater in children with late rescues and PICU readmissions and if a cutoff PASS values exist to discriminate these events prior to intrafacility transfer.

Results: Nine (5%) late-rescues and 5 (3%) PICU readmissions accounted for 14/328 (4%) composite outcomes. PASS values were greater in children with these events (8 [IQR:5–8] vs. 5 [IQR:3–6], p < .01). Logistic regression of PASS on composite outcome yielded an odds ratio of 1.4 (1.1–1.8, p < .01) and ROC curve of PASS on a composite outcome yielded an AUC of 0.74 (0.61–0.87) with a threshold of ≥ 9. Nine (3%) children experienced unplanned 30-day hospital readmissions but PASS preceding hospital discharge was neither discriminative nor associated with hospital readmission.

Conclusions: PASS values ≥ 9 identify children at increased risk for late-rescue and PICU readmission. Applied with traditionally criteria for selection of inpatient level of care, PASS may assist providers in reducing acute inpatient disposition errors.

Keywords:

• Asthma
• inpatient level of care
• late rescue
• pediatric asthma severity score
• pediatric intensive care unit
• unplanned readmission

Additional information

Funding

Dr. Nakagawa receives author royalties from Wolters Kluwer, UpToDate^© and was a consultant for Fresenius Kabi. The remaining authors have indicated they have no financial relationships relevant to this article to disclose.