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Ohio Pediatric Asthma Repository: Opportunities to Revise Care Practices to Decrease Time to Physiologic Readiness

Jeffrey M Simmons1,2, Jocelyn M Biagini Myers3,2, Lisa J Martin4,2

  • 1Divisions of Hospital Medicine.

Hospital Pediatrics
|May 17, 2018
PubMed

Insights

Pediatric asthma exacerbation care varies significantly by hospital. Early dexamethasone and other interventions shorten hospital stays, but a standardized severity measure is needed for better outcomes.

Area of Science:

  • Pediatric Pulmonology
  • Healthcare Systems Research
  • Asthma Management

Background:

  • Limited large-scale studies exist on factors influencing pediatric asthma exacerbation outcomes.
  • Investigated patient-level risks and system-level practices affecting physiologic readiness for discharge (PRD).

Purpose of the Study:

  • To examine patient and system factors impacting PRD timing in pediatric asthma exacerbations.
  • To identify best practices for inpatient asthma treatment.

Main Methods:

  • Prospective study of 1005 children (ages 2-17) hospitalized for asthma exacerbation.
  • Collected data on demographics, disease characteristics, and hospital care practices.
  • Primary outcome: time to PRD, defined as first 4-hour albuterol spacing post-admission/ED presentation.

Main Results:

  • Significant variation in care practices and time to PRD across hospitals.
  • Continuous pulse oximetry prolonged PRD time (P=.004).
  • ED dexamethasone administration shortened PRD time (P<.001) and reduced ICU/IV steroid use (P<.0001).
  • Earlier chest radiograph, antibiotics, and IV steroids associated with shorter PRD (P<.05).

Conclusions:

  • Substantial variation exists in pediatric inpatient asthma care practices.
  • Modifiable system-level factors and therapies influence PRD and require further investigation.
  • Lack of a standardized asthma exacerbation severity measure hinders comparative effectiveness research.
Abstract

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