Predictors for critical care admission among children presenting to emergency department with recurrent wheezing

Children with recurrent wheezing contribute to a significant burden of inpatient hospital admission in developing countries. However, many patients could be managed at home following a short observation period in emergency unit.

This study aimed to determine the predictors of critical care admission in a population of children aged 6 months to 2 years attending pediatric emergency department (ED) for recurrent wheezing.

This is a case-control study conducted in pediatric ED of a tertiary care center in North India.

Demographic and clinical details were recorded for children aged 6 months to 2 years who presented to ED for "recurrent wheezing" within 48 h of onset of symptoms. Those who were admitted to critical care unit were considered cases and those who were discharged within 6 h of stay at short observation units of ED were considered controls.

Logistic regression model was used to determine which of the various demographic and clinical factors best predicted the need for critical care admission.

The cases (n = 58) had significantly higher number of emergency visits in the preceding 1 month (P = 0. 018), had more episodes of wheezing in the last 3 months (P = 0.025), had higher respiratory rate (P < 0.001), and had higher clinical severity score (P < 0.001) when compared to control (n = 58) group. Logistic regression model revealed incomplete immunization status of children (P = 0.005) to be a significant risk factor that determine the need for critical care admission.

The present cross-sectional study with limited sample size revealed incomplete immunization status of children to be a significant risk factor that determined the need for critical care admission among children below 2 years of age presenting to ED with recurrent wheezing.