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Increase in admission threshold explains stable asthma hospitalization rates
M J Russo1, K M McConnochie, J T McBride
1Albert Einstein College of Medicine, Bronx, New York, USA.
Pediatrics
|September 2, 1999
Summary
Childhood asthma hospitalizations remained stable overall, but severe asthma cases increased significantly. This suggests healthcare systems may be raising admission thresholds in response to increased asthma severity.
Area of Science:
- Pediatric pulmonology
- Health services research
- Epidemiology
Background:
- Asthma morbidity and mortality have risen, yet hospitalization rates remain stable for many groups.
- Understanding hospitalization trends offers insight into healthcare system performance during reform.
Purpose of the Study:
- To analyze changes in childhood asthma hospitalization rates and severity from 1991 to 1995.
- Investigate trends in pediatric asthma acute episodes.
Main Methods:
- Studied 20,280 asthma hospitalizations among children under 19 in Monroe County, NY (1991-1995).
- Assessed severity using worst oxygen saturation (SaO(2)) within 24 hours of admission.
- Categorized episodes as mild (SaO(2) ≥95), moderate (90-94), or severe (SaO(2) <90).
Main Results:
- Overall asthma hospitalization rates remained stable (1.90 to 2.31 per 1000 child-years).
- Hospitalization rates for severe asthma increased by 270% (0.57 to 1.55).
- Mild asthma hospitalizations decreased, and severe episodes constituted a larger proportion of total asthma hospitalizations (31.5% to 60.4%).
Conclusions:
- Childhood asthma hospitalizations show a significant increase in severity despite stable overall rates.
- The healthcare system may be adjusting its admission criteria, admitting only more severe asthma cases.
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