Avoidable Emergency Visits for Acute Asthma in Children: Prevalence and Risk Factors

Emergency department (ED) visits for asthma exacerbation have not become less frequent, essentially because the self-management of mild-to-moderate asthma exacerbations by children and their families remains sub-optimal. The objective of our study was to assess the proportion of visits to EDs for asthma exacerbation that were potentially avoidable and their risk factors [such as no Written Asthma Action Plan (WAAP)]. We conducted an 8-month multicenter study in 6 French pediatric EDs. Parents, nurses, and physicians filled out a questionnaire, recording information on the history of asthma and education (peak flow, WAAP), the self-management of the present exacerbation, the reasons for coming to the ED, the severity of the exacerbation, and the clinical outcome. An ED visit was deemed as potentially avoidable when a child who had not received adequate prehospital treatment left the ED after a maximum of 3 nebulizations with a bronchodilator with no relapse within 48 h. We included 107 children [mean (standard deviation) age 9.8 (2.4) years, 40% were girls]. At arrival, 76 children [71%, 95% confidence interval (CI): 62-80] had not received adequate treatment for the current exacerbation. Forty-one children (38%, 95% CI: 29-48) had an avoidable ED visit. Feelings of fear/anxiety were the only independent risk factor for avoidable visits, whereas the existence of a WAAP at home did not independently influence avoidable visits. Inadequate prehospital treatment and avoidable visits are frequent in children with known asthma visiting EDs for an asthma exacerbation. Strategies to reduce avoidable visits should seek to improve the WAAP, to develop and validate new electronic tools for self-managed interventions, and to provide reassurance.