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Risk Factors Associated With Escalation of Therapy in Hospitalized Children With Asthma
Florinda Islamovic1, Patricia Hametz1, Jonathan M Gabbay1
1Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore Einstein, Bronx, New York.
Insights
Children hospitalized for asthma exacerbations may need escalation of therapy (EOT). Risk factors include older age, Hispanic or multiracial ethnicity, and complex chronic conditions, aiding early risk stratification for better care.
Area of Science:
- Pediatric Pulmonology
- Healthcare Informatics
- Epidemiology
Background:
- Asthma exacerbations are a common reason for pediatric hospitalization.
- Escalation of therapy (EOT) is sometimes required but risk factors are not well understood.
- Identifying EOT predictors can optimize inpatient asthma management.
Purpose of the Study:
- To identify risk factors associated with escalation of therapy (EOT) in hospitalized children with asthma exacerbations.
- To inform targeted interventions and improve the quality of inpatient asthma care.
- To provide data for early risk stratification of pediatric asthma patients.
Main Methods:
- Retrospective cohort study of 92,224 pediatric asthma exacerbation encounters (2018-2023) across 45 children's hospitals.
- EOT defined as ICU transfer, advanced respiratory support, or specific adjunctive therapies after the first hospital day.
- Mixed-effects regression analysis to assess associations between EOT and patient/demographic factors.
Main Results:
- 17.34% of encounters required EOT.
- Higher EOT odds observed in older children (adolescents/adults), Hispanic and multiracial patients, and those with complex chronic conditions (CCC).
- Lower EOT odds seen in male patients; Child Opportunity Index (COI) and insurance were not significant predictors.
Conclusions:
- Key risk factors for EOT in pediatric asthma hospitalizations were identified.
- Findings support early risk stratification and may highlight modifiable aspects of inpatient care.
- Further research is needed to explore these associations and enhance asthma management strategies.
Objective:
Children hospitalized for asthma exacerbations may require escalation of therapy (EOT), but risk factors remain poorly defined. We aimed to identify risk factors for EOT to inform interventions and improve care.
Patients And Methods:
We conducted a retrospective cohort study using the Pediatric Health Information System of hospitalized children aged 4 to 18 years with a diagnosis of an asthma exacerbation from January 1, 2018, to December 31, 2023, across 45 children's hospitals. EOT was defined as intensive care unit transfer, advanced respiratory support, or adjunctive asthma therapy (ie, magnesium sulfate, methylprednisolone) after the first hospital day. Mixed-effects regression estimated the association between EOT and risk factors: age, sex, race and ethnicity, insurance, Child Opportunity Index (COI), complex chronic conditions (CCC), and season.
Results:
Among 92 224 encounters, 15 989 (17.34%) required EOT. Adjusted analysis showed lower odds of EOT in male patients (adjusted odds ratio [aOR], 0.91 [CI, 0.88, 0.94]) and spring compared with summer admissions (aOR, 0.93 [0.88, 0.99]). Compared with early childhood (<5 years), the odds of EOT were higher in late childhood (5-12 years) (aOR, 1.19 [1.13, 1.26]), adolescence (13-17 years) (aOR, 1.48 [1.38, 1.59]), and adults (≥18 years) (aOR, 1.43 [1.17, 1.73]). Higher odds were observed in Hispanic (aOR, 1.07 [1.00, 1.14]) and multiracial (aOR, 1.17 [1.02, 1.34]) patients and those with CCC (aOR, 2.07 [1.95, 2.19]). COI and insurance were not significantly associated with EOT.
Conclusion:
We identified key risk factors for EOT in children hospitalized for asthma exacerbations. Such findings can help with early risk stratification or serve as proxies for modifiable features of inpatient care. Further research is warranted to explore these associations to improve care.
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