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Secondhand smoke exposure, illness severity, and resource utilization in pediatric emergency department patients with
Ashley L Merianos1, Cinnamon A Dixon2, E Melinda Mahabee-Gittens3
1a School of Human Services, University of Cincinnati , Cincinnati , OH , USA.
Insights
Children exposed to secondhand smoke (SHS) with asthma or bronchiolitis experienced more severe illnesses and required greater healthcare resources in the pediatric emergency department. This highlights the need for SHS assessment and cessation programs.
Area of Science:
- Pediatric Emergency Medicine
- Environmental Health
- Respiratory Medicine
Background:
- Secondhand smoke exposure (SHSe) in children is linked to severe respiratory illnesses and increased healthcare utilization.
- Hospital data indicate a significant impact of SHSe on pediatric respiratory health outcomes.
Purpose of the Study:
- To evaluate the association between SHSe and illness severity/resource utilization in children presenting to the pediatric emergency department (PED).
- To analyze these associations for three common pediatric respiratory conditions: asthma, bronchiolitis, and pneumonia.
Main Methods:
- A retrospective review of a yearlong sample of PED patients with documented SHSe status and diagnoses of asthma, bronchiolitis, or pneumonia.
- Analysis included variables such as triage category, oxygen saturation, diagnostic tests, interventions, medications, and patient disposition.
- Logistic and linear regression models were used to control for confounding factors like sociodemographics and medical history.
Main Results:
- Approximately one-quarter of the 3,229 included children had documented SHSe.
- Children with SHSe and asthma were more likely to receive corticosteroids and magnesium sulfate.
- Children with SHSe and bronchiolitis showed increased likelihood of receiving racemic epinephrine, chest X-rays, and hospital admission.
Conclusions:
- Secondhand smoke-exposed children with asthma or bronchiolitis exhibit greater illness severity and resource utilization.
- Findings underscore the critical need for SHSe assessment, cessation interventions, and further research within the PED setting.
Objective:
Hospital-based data reveal that children who have secondhand smoke exposure (SHSe) experience severe respiratory illnesses and greater resource utilization. Our objective was to assess the relationship between SHSe and illness severity/resource utilization among children presenting to the pediatric emergency department (PED) with three common respiratory conditions-asthma, bronchiolitis, and pneumonia.
Methods:
A retrospective review of a yearlong consecutive sample of PED patients with SHSe status documentation and asthma, bronchiolitis, or pneumonia diagnoses was performed. PED illness severity/resource utilization variables included triage categorization, initial oxygen saturation, evaluation/testing (influenza A & B, respiratory syncytial virus, chest X-ray), procedures/interventions performed (supplemental oxygen, suctioning, intubation), medications administered, and disposition. Logistic and linear regression models were conducted to determine differences in each diagnosis group while controlling for sociodemographics, medical history, seasonality, and insurance type.
Results:
There were 3,229 children with documentation of SHSe status and an asthma (41%), bronchiolitis (36%), or pneumonia (23%) diagnosis. Across diagnosis groups, approximately 1/4 had positive documentation of SHSe. Asthmatic children with SHSe were more likely to receive corticosteroids (odds ratio (OR) = 1.71, 95% confidence interval (CI) = 1.19, 2.44) and/or magnesium sulfate (OR = 1.66, 95% CI = 1.14, 2.40). Children with SHSe and bronchiolitis were more likely to receive racemic epinephrine (OR = 2.48, 95% CI = 1.21, 5.08), have a chest X-ray (OR = 1.36, 95% CI = 1.00, 1.85), and/or be admitted (OR = 1.46, 95% CI = 1.09, 1.95). No differences in illness severity/resource utilization were identified for children with pneumonia.
Conclusions:
SHS-exposed children with asthma or bronchiolitis have greater illness severity/resource utilization. Our findings highlight the importance of SHSe assessment, cessation, and research efforts in the PED setting.
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