Analysis of medication patterns for pediatric asthma patients in emergency department: Does the sequence placement of glucocorticoids administration matter?

Abstract

Objectives: Timely glucocorticoid administration is associated with decreased admission rate and is thus a common quality metric for ED asthma care; less is known about the impact of the timing of glucocorticoids in the context of the sequence of asthma medications administered. Therefore, we investigated the distribution of asthma medication sequences in one ED and analyzed the effect of the sequence placement of glucocorticoids administration on treatment outcomes.

Methods: A retrospective study using five-year electronic health record data obtained from an academic urban children’s hospital ED was conducted. We clustered the sequences of medication administration using an exact string-matching algorithm to identify the most frequently used asthma medication sequences. Then, we used the identified patterns to perform statistical tests to examine the effect of the sequence placement of glucocorticoids administration on the outcomes length-of-stay and ED disposition.

Results: A total of 4,844 encounters were included in our study. The ten most common treatment sequences accounted for 43% of all encounters. Stratified analyses confirmed that treatment sequences pattern was correlated with patient severity, but ED crowding does not impact treatment sequences. In multivariable models, glucocorticoids administration earlier in the treatment sequence was associated with shorter length of stay and lower hospital admission rates.

Conclusions: By analyzing medication sequence patterns for the ED encounter of pediatric asthma, we found that the earlier sequence placement of glucocorticoids administration is associated with improved outcomes. Our findings can help inform quality improvement and clinical guideline development related to ED asthma care for children.

Keywords:

• Emergency department
• exact-string matching algorithm
• pediatric asthma
• timely healthcare delivery
• treatment sequences

Acknowledgements

This study was supported by University of Colorado College of Nursing and NIH/NCATS Colorado CTSA Grant Number UL1 TR002535. Contents are the authors' sole responsibility and do not necessarily represent official NIH views.

Notes

1 We conducted another stratified analyses according to ED crowding level, and found that the top 10 list of treatment sequences did not significantly differ, and therefore we do not report the detailed results.

2 Because we used a large-size dataset collected over many years, some could be entered the ED multiple times (multiple visits by the same patients), and this may have distorted our key findings. To examine whether this affects our key findings, we have conducted additional experiments. The experimental results show that our key findings are still valid, even when such duplications are eliminated. The detailed experimental results are provided in the Supplemental Materials.