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Published on: August 7, 2017
Prospective study of sudden-onset asthma exacerbations in children
Hanan A Sedik1, R Graham Barr, Sunday Clark
1Division of Emergency Medicine, Childrens Hospital Los Angeles, Los Angeles, CA 90027, USA. hsedik@chla.usc.edu
Insights
Sudden-onset asthma in children presents similarly to slower-onset cases but shows quicker emergency department (ED) treatment responses. These children experienced shorter ED stays and fewer hospital admissions, indicating faster recovery.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Medicine
- Clinical Pediatrics
Background:
- Asthma exacerbations in adults show varied treatment responses based on onset speed.
- Understanding these differences in children is crucial for effective emergency department (ED) management.
Purpose of the Study:
- To investigate if sudden-onset asthma exacerbations in children exhibit faster treatment responses in the ED compared to slower-onset exacerbations.
- To compare clinical characteristics and outcomes between sudden-onset and slower-onset asthma exacerbations in pediatric ED patients.
Main Methods:
- Prospective cohort study involving 1184 children aged 2-17 years across 44 North American EDs.
- Data collected through structured ED interviews and 2-week follow-up telephone interviews with parents.
- Asthma onset was categorized based on ED presentation time relative to symptom onset.
Main Results:
- 11% of children experienced sudden-onset asthma (presentation within 3 hours of symptom onset).
- Sudden-onset patients were older, more likely to be white, and had less prior steroid use or hospitalizations.
- Despite similar initial severity, sudden-onset asthma had shorter ED length of stay and lower admission rates.
Conclusions:
- Children with sudden-onset asthma exacerbations demonstrate a more rapid response to ED treatment.
- These patients experienced shorter ED stays and reduced hospital admission rates compared to those with slower-onset exacerbations.
- Findings suggest distinct management pathways may be beneficial for different asthma onset types in pediatric ED settings.
Objectives:
Sudden-onset asthma exacerbations among adults have more rapid treatment responses than do slower-onset exacerbations. We hypothesized that a similar pattern would be evident in children presenting to the emergency department (ED) with an asthma exacerbation.
Methods:
Prospective cohort study at 44 North American EDs. Parents of children, aged 2 to 17 years, underwent a structured interview in the ED and follow-up interview by telephone 2 weeks later.
Results:
Of 1184 enrolled children, 11% had sudden-onset asthma (ED presentation < or = 3 hours after symptom onset). Sudden-onset patients were older than slower-onset patients (8.9 vs. 7.7 years, respectively; P = 0.004) and more likely to be white (26% vs. 17%, P = 0.01). They were less likely to report a history of steroid use or asthma hospitalization and reported fewer ED asthma visits during the past year (all P < 0.05). Although initial pulmonary index scores were similar (4.0 vs. 4.3, P = 0.24), patients with sudden-onset asthma were less likely to receive steroid treatment (73% vs. 84%, P = 0.002), had shorter ED length of stay (128 minutes vs. 150 minutes, P = 0.01), and in unadjusted analyses, were less likely to be admitted (16% vs. 24%, P = 0.04).
Conclusions:
Patients with sudden-onset exacerbations had similar acute asthma severity as those with slower-onset exacerbations but had shorter ED length of stay and were less likely to be admitted to the hospital, suggesting a more rapid response to treatment.
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