Factors associated with hospital admission in adult patients with asthma exacerbations: A systematic review

ABSTRACT

Objectives: A variable proportion of patients presenting to the emergency department (ED) with acute asthma require admission to hospital. Previous studies have identified select factors associated with admission following ED presentation; however, no review has synthesized the evidence in this regard. This systematic review summarizes the evidence regarding factors associated with hospital admission following ED presentation. Methods: Searches were conducted in seven electronic databases and common sources of grey literature. Studies reporting disposition for adults after ED presentation were included. Admission proportions and factors associated with hospitalization that remained statistically significant in multivariable analyses (p < 0.05) were reported. Results: Out of an initial 5865 identified articles, 15 articles met full inclusion criteria and 11 were included in the analyses. Female sex (n = 2) and older age (n = 2) were individual factors associated with admission. Patient vital signs and severity followed by patient attributes were the two most frequent domains associated with admission. Admission proportions were analyzed in 10 studies at an median of ∼20% with no clear change between 1996 and 2012. Conclusions: Factors such as patient demographics (e.g., female sex, older age), patient vital signs/severity, and history are associated with admission following ED presentation for acute asthma. These can be employed by ED clinicians to effectively discern patients at high risk for admission and lead to more evidence-based decision-making.

KEYWORDS:

• Exacerbations
• factors associated
• predictors
• prospective
• synthesis

Acknowledgements

The authors would like to thank Scott Kirkland for his collaboration throughout the project.

Conflicts of interest

The authors have no conflicts of interest to declare related to this topic. Dr. Rowe (BHR) was the primary author in one included study; however, BHR was excluded from the selection of potentially eligible manuscripts and final inclusion/exclusion decisions.

Additional information

Funding

Nicholas Arrotta was funded by the Respiratory Health Strategic Clinical Network (RHSCN) of Alberta Health Services. Jesse Hill was funded by an Alberta Innovates Health Solutions (AIHS) Summer Studentship. During this study, Dr. Villa-Roel was supported by Canadian Institutes of Health Research (CIHR) in partnership with the Knowledge Translation Branch (Ottawa, Ontario). Dr. Rowe's research is supported by CIHR through a Tier I Canada Research Chair in Evidence-based Emergency Medicine (Ottawa, Ontario), he is the scientific director of the Emergency SCN, and a member of the RHSCN. The funders take no responsibility for the conduct, analyses, and interpretation of these results.