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Risk factors for readmission to hospital for asthma in childhood
E A Mitchell1, J M Bland, J M Thompson
1Department of Paediatrics, School of Medicine, University of Auckland, New Zealand.
Insights
Pediatric asthma readmissions are common, with female sex, young age, and prior admissions increasing risk. Inpatient intravenous treatment also raised readmission rates, while theophylline use decreased them.
Area of Science:
- Pediatric Pulmonology
- Epidemiology
- Hospital Readmission Studies
Background:
- Childhood asthma hospital readmissions contribute to rising admission rates globally.
- Understanding readmission patterns is crucial for improving pediatric asthma care.
Purpose of the Study:
- To identify demographic, clinical, and management factors associated with hospital readmissions in children with asthma.
- To inform strategies aimed at reducing the high rate of pediatric asthma readmissions.
Main Methods:
- An observational study involving 1034 children hospitalized for asthma.
- Data collected on demographics, asthma severity, treatment, and management.
- Follow-up period of up to 33 months to track readmissions.
Main Results:
- Readmission rates were substantial: 33% by six months and 51% by two years.
- Factors significantly increasing readmission risk included female sex, younger age (<5 years), and a higher number of previous admissions.
- Inpatient intravenous treatment was associated with increased readmissions, whereas theophylline use was linked to decreased readmissions.
Conclusions:
- Readmission risk is influenced by individual patient characteristics (age, sex) and disease severity (indicated by previous admissions and treatment needs).
- Current medical treatment and management approaches did not appear to significantly impact readmission rates.
- Development of targeted strategies is necessary to mitigate the high readmission rates for childhood asthma.
Background:
Readmissions account for part of the increase in hospital admissions for asthma in childhood seen in many countries.
Methods:
This observational study recorded demographic features and the severity, treatment and management of asthma in 1034 individual children admitted to hospital over a one year period, followed for a maximum of 33 months.
Results:
Readmissions were common, with 33% readmitted by six months and 51% by two years. After controlling for a wide range of variables, factors that significantly increased readmission were: female sex (relative risk (RR) 1.23; 95% confidence interval (CI) 1.03 to 1.46), young age (age < 5 years RR 1.71; 95% CI 1.41 to 2.08), number of previous admissions (one previous admission RR 1.32; two, RR 1.68; three, RR 2.00; four or more, RR 2.80), and inpatient intravenous treatment (RR 1.29; 95% CI 1.08 to 1.55). Inpatient treatment with theophylline was used frequently (98.4%), but was associated with decreased readmissions (RR 0.51, 95% CI 0.28 to 0.92). Factors which did not predict readmission included ethnicity, respiratory and pulse rate, medical team, prescribed prophylactic treatment, type of follow up, or the use of action plans.
Conclusions:
Risk factors for readmission relate to the characteristics of the individual (age and sex), severity of the condition (intravenous treatment), and number of previous admissions which may reflect severity or behaviour of the illness. Medical treatment and management did not influence readmissions. Strategies to reduce the high readmission rate for asthma in childhood need to be developed.