Risk Factors for Repeat Adverse Asthma Events in Children After Visiting an Emergency Department

To, Teresa; Wang, Chengning; Dell, Sharon; Fleming-Carroll, Bonnie; Parkin, Patricia; Scolnik, Dennis; Ungar, Wendy; PAMG Team,

doi:10.1016/j.ambp.2008.04.008

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Volume 8, Issue 5 , Pages 281-287, September 2008

Risk Factors for Repeat Adverse Asthma Events in Children After Visiting an Emergency Department

Teresa To, PhD
- Address correspondence to Teresa To, PhD, Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
Chengning Wang, MD, MSc
Sharon Dell, MD, FRCP(C)
Bonnie Fleming-Carroll, MN, ACNP
Patricia Parkin, MD, FRCP(C)
Dennis Scolnik, MD, FRCP(C)
Wendy Ungar, PhD
PAMG Team
- The Pediatric Acute Asthma Management Guideline (PAMG) Team includes Peter Bikangaga, MD, FRCP(C), William Osler Health Centre, Brampton, Ontario, Canada; Constantine Petrou, MD, FRCP(C), Toronto East General Hospital, Toronto, Ontario, Canada; Ian MacLusky, MBBS, FRCP(C), May Ghulmiyyah, MPH, Azim Shahsavar, MD, and Miki Zlatanovski, MD, The Hospital for Sick Children, Toronto, Ontario, Canada; and Joseph Reisman, MD, FRCP(C), MBA, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.

From the Child Health Evaluative Sciences, Research Institute (Dr To, Dr Wang, Dr Dell, Dr Parkin, and Dr Ungar), Department of Pediatrics (Dr To, Dr Dell, and Dr Parkin), Department of Respiratory Medicine (Dr To, Dr Dell, and Ms Fleming-Carroll), and Department of Emergency Medicine (Dr Scolnik), The Hospital for Sick Children, Toronto, Ontario, Canada; and The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (Dr Ungar)

Received 4 December 2007; accepted 26 April 2008. published online 01 July 2008.

Objective

The aim of this study was to identify risk factors for long-term adverse outcomes in children with asthma after visiting the emergency department (ED).

Methods

A prospective observational study was conducted at the ED of a pediatric tertiary hospital in Ontario, Canada. Patient outcomes (ie, acute asthma episodes and ED visits) were measured at baseline and at 1- and 6-months post-ED discharge. Time trends in outcomes were assessed using the generalized estimating equations method. Multiple conditional logistic regressions were used to model outcomes at 6 months and examine the impact of drug insurance coverage while adjusting for confounders.

Results

Of the 269 children recruited, 81.8% completed both follow-ups. ED use significantly reduced from 39.4% at baseline to 26.8% at 6 months (P < .001), whereas the level of acute asthma episodes remained unchanged. Children with drug insurance coverage were less likely to have acute asthma episodes (adjusted odds ratio [AOR] = 0.36; 95% CI, 0.15–0.85; P < .02) or repeat ED visits (AOR = 0.45; 95% CI, 0.20–0.99; P < .05) at 6 months. Other risk factors for adverse outcomes included previous adverse asthma events and certain asthma triggers (eg, cold/sinus infection). Washing bed linens in hot water weekly was protective against subsequent acute asthma episodes.

Conclusions

Our study demonstrated significant improvements in long-term outcomes in children seeking acute care for asthma in the ED. Future efforts remain in targeting the sustainability of improved outcomes beyond 6 months. Risk factors identified can help target vulnerable populations for proper interventions, which may include efforts to maximize insurance coverage for asthma medications and strategies to improve asthma self-management through patient and provider education.

Key Words: asthma, children, drug insurance coverage, emergency department visit, risk factors