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Risk factors for intensive care admission in children with severe acute asthma in the Netherlands: a prospective
Shelley A Boeschoten1, Annemie L Boehmer2,3, Peter J Merkus4
1Intensive Care and Dept of Paediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands.
Insights
Severe acute asthma (SAA) in children is often preventable. Key risk factors for pediatric intensive care unit (PICU) admission include prolonged symptoms and tobacco smoke exposure, not steroid-naïve status.
Area of Science:
- Pediatric critical care medicine
- Respiratory medicine
- Asthma research
Background:
- Severe acute asthma (SAA) admissions to pediatric intensive care units (PICU) have increased.
- A prior study noted a rise in SAA PICU admissions, coinciding with more children lacking inhaled corticosteroid (ICS) treatment.
Purpose of the Study:
- To investigate if children with SAA who have not used steroids are at higher risk for PICU admission.
- To identify secondary risk factors for PICU admission in SAA, including tobacco smoke exposure, allergies, prior admissions, and viral infections.
Main Methods:
- A prospective, nationwide, multicenter study involving children aged 2-18 years with SAA.
- Data collected from all Dutch PICUs and four general wards between 2016 and 2018.
- Logistic regression analyses were used to assess risk factors for PICU admission.
Main Results:
- No significant difference in the proportion of steroid-naïve children between PICU and general ward admissions.
- PICU patients were older, had longer symptom duration (>1 week), and higher tobacco smoke exposure.
- Viral susceptibility was not a significant risk factor for PICU admission.
Conclusions:
- Steroid-naïve status was not a differentiating factor for PICU admission in SAA.
- Prolonged symptoms (>7 days) without adjusted therapy and tobacco smoke exposure are significant, preventable risk factors for PICU admission.
- Clinicians treating pediatric asthma should be aware of these risk factors to prevent severe outcomes.
Rationale:
Severe acute asthma (SAA) can be fatal, but is often preventable. We previously observed in a retrospective cohort study, a three-fold increase in SAA paediatric intensive care (PICU) admissions between 2003 and 2013 in the Netherlands, with a significant increase during those years of numbers of children without treatment of inhaled corticosteroids (ICS).
Objectives:
To determine whether steroid-naïve children are at higher risk of PICU admission among those hospitalised for SAA. Furthermore, we included the secondary risk factors tobacco smoke exposure, allergic sensitisation, previous admissions and viral infections.
Methods:
A prospective, nationwide multicentre study of children with SAA (2-18 years) admitted to all Dutch PICUs and four general wards between 2016 and 2018. Potential risk factors for PICU admission were assessed using logistic regression analyses.
Measurements And Main Results:
110 PICU and 111 general ward patients were included. The proportion of steroid-naïve children did not differ significantly between PICU and ward patients. PICU children were significantly older and more exposed to tobacco smoke, with symptoms >1 week prior to admission. Viral susceptibility was not a significant risk factor for PICU admission.
Conclusions:
Children with SAA admitted to a PICU were comparable to those admitted to a general ward with respect to ICS treatment prior to admission. Preventable risk factors for PICU admission were >7 days of symptoms without adjustment of therapy and exposure to tobacco smoke. Physicians who treat children with asthma must be aware of these risk factors.
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