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Childhood asthma admissions: determinants of short stay
S D Dell1, P C Parkin, C Macarthur
1Division of Paediatric Medicine and the Paediatric Outcomes Research Team, Department of Paediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Canada.
Insights
Milder asthma, male gender, and home inhaler devices predict shorter hospital stays for pediatric asthma exacerbations. This suggests alternative care models for these children.
Area of Science:
- Pediatric Pulmonology
- Healthcare Management
- Epidemiology
Background:
- Acute asthma exacerbations frequently lead to pediatric hospitalizations.
- Understanding factors influencing hospital stay duration is crucial for resource allocation and care optimization.
Purpose of the Study:
- To identify determinants of short hospital stays (< 24 hours) in children hospitalized for acute asthma exacerbations.
- To inform the development of alternative healthcare delivery models for pediatric asthma patients.
Main Methods:
- Retrospective analysis of computerized health records for children diagnosed with asthma (ICD code 493.0).
- Comparison of clinical and demographic data between a short-stay group (< 24 hours) and a long-stay group (> 24 hours).
- Logistic regression analysis to identify predictors of short hospital stay.
Main Results:
- 25% of 485 children had short-stay admissions (< 24 hours).
- Milder asthma severity (adjusted OR 4.9), male gender (adjusted OR 2.4), and home availability of a delivery device (adjusted OR 2.0) were significantly associated with short hospital stays.
- No significant differences were found in pre-hospital management, emergency department presentation, or observation unit use.
Conclusions:
- Short hospital stays for pediatric asthma exacerbations are common and can be costly.
- Identifying key predictors allows for targeted interventions and potentially reduces healthcare expenditure.
- Alternative healthcare models should be explored for children with asthma requiring brief hospital contact.
Abstract:
The objective of this study was to identify the determinants of short hospital stay (< 24 h) among children admitted because of an acute asthma exacerbation. Computerized health records were used to identify children with a discharge diagnosis of asthma (ICD code 493.0) at the Hospital for Sick Children, Toronto, during the period October 1994 to October 1995. Cases were children with a length of hospital stay of < 24 h (short-stay group) and controls were children with a length of stay of > 24 h (long-stay group). Clinical and demographic data were extracted from the medical record. Over the 12-month period, 485 children were hospitalized because of asthma. Of these, 121 (25%) had short-stay admissions (< 24 h), whereas 364 (75%) had long-stay admissions (> 24 h). Simple random sampling was used to select 85 children from each of the two groups. There were no differences between the two groups regarding language, primary care physician, asthma history, management prior to emergency department (ED) presentation, respiratory rate on presentation, use of the observation unit, and time in the ED. Logistic regression analyses identified three variables associated with short hospital stay: milder asthma (adjusted odds ratio [OR] 4.9), male gender (adjusted OR 2.4), and availability of a delivery device at home (adjusted OR 2.0). In conclusion, many children admitted to hospital because of an asthma exacerbation have short, yet expensive, hospital stays. The results of this study highlight the importance of developing alternative models of health care delivery for asthmatic children requiring short hospital contact.