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An Assessment of Asthma Therapy in the Pediatric ICU
Michelle Bosley Henderson1, Jeff E Schunk2, Jeffrey L Henderson3
1Department of Pediatrics, School of Medicine, University of Utah and Primary Children's Hospital, Salt Lake City, Utah; and meshrain@gmail.com.
Insights
Most pediatric intensive care unit (PICU) patients with severe asthma received minimal interventions. Reducing PICU length of stay is key to lowering asthma care costs.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Medicine
- Health Services Research
Background:
- Asthma is a common chronic respiratory disease in children.
- Severe asthma exacerbations often require pediatric intensive care unit (PICU) admission.
- Understanding resource utilization and management variations in the PICU is crucial for optimizing care and reducing costs.
Purpose of the Study:
- To describe current asthma management practices in the PICU.
- To investigate variations in asthma care delivery.
- To analyze asthma-associated healthcare charges and resource use.
Main Methods:
- Retrospective, single-center cohort study of 262 pediatric patients (ages 2-18) admitted to the PICU for status asthmaticus between 2008-2011.
- Data collected from the Intermountain Healthcare Enterprise Data Warehouse.
- Patients grouped by maximal respiratory support intervention.
Main Results:
- 70% of patients received minimal respiratory support (nasal cannula or nonrebreather mask) and first-tier therapies.
- Medical imaging and laboratory charges represented <3% and <5% of total costs, respectively.
- Intubated patients, particularly those intubated at the facility, experienced significantly longer PICU length of stay.
Conclusions:
- The majority of severe asthma cases in the PICU were managed with conservative interventions.
- Minimizing PICU length of stay is a primary strategy for reducing healthcare expenses associated with asthma management.
Objectives:
To describe asthma management, investigate practice variation, and describe asthma-associated charges and resource use during asthma management in the PICU.
Methods:
Children ages 2 to 18 years treated for status asthmaticus in the PICU from 2008 to 2011 are included in this study. This is a retrospective, single-center, cohort study. Data were collected by using the Intermountain Healthcare Enterprise Data Warehouse.
Results:
There were 262 patients included and grouped by maximal respiratory support intervention. Seventy percent of the patients did not receive escalation of respiratory support beyond nasal cannula or nonrebreather mask, and the majority of these patients received only first-tier recommended therapy. For all patients, medical imaging and laboratory charge fractions accounted for <3% and <5% of the total charges, respectively. Among nonintubated patients, the majority of these diagnostic test results were normal. Fifteen patients were intubated during our study period; 4 were intubated at our facility. Compared with outside hospital intubations, these 4 patients had longer time to intubation (>3 days versus <24 hours) and significantly longer median PICU length of stay (12.7 days versus 2.6 days).
Conclusions:
In our study, the vast majority of patients with severe asthma were treated with minimal interventions alone (nasal cannula or nonrebreather mask and first-tier medications). Minimizing PICU length of stay is likely the most successful way to decrease expense during asthma care.
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