Jeffrey M Simmons1,2, Jocelyn M Biagini Myers3,2, Lisa J Martin4,2, Carolyn M Kercsmar5,2, Christine L Schuler1,2, Valentina V Pilipenko4, John W Kroner3, Hua He4, Stephen R Austin3, Huyen-Tran Nguyen3, Kristie R Ross6, Karen S McCoy7, Sherman J Alter8, Samantha M Gunkelman9, Pierre A Vauthy10, Gurjit K Khurana Hershey11,2. 1. Divisions of Hospital Medicine. 2. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio. 3. Asthma Research. 4. Human Genetics, and. 5. Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 6. Department of Pediatrics-Pulmonary, Rainbow Babies and Children's Hospital, Cleveland, Ohio. 7. Division of Pediatric Pulmonology, Nationwide Children's Hospital, Columbus, Ohio. 8. Department of Infectious Disease, Dayton Children's Hospital, Dayton, Ohio. 9. Division of Pediatric Hospital Medicine, Akron Children's Hospital, Akron, Ohio. 10. Department of Pediatric Pulmonary Medicine, ProMedica Toledo Children's Hospital, Toledo, Ohio; and. 11. Asthma Research, gurjit.hershey@cchmc.org.
Abstract
BACKGROUND: Large-scale, multisite studies in which researchers evaluate patient- and systems-level factors associated with pediatric asthma exacerbation outcomes are lacking. We sought to investigate patient-level risks and system-level practices related to physiologic readiness for discharge (PRD) in the prospective Ohio Pediatric Asthma Repository. METHODS: Participants were children ages 2 to 17 years admitted to an Ohio Pediatric Asthma Repository hospital for asthma exacerbation. Demographics, disease characteristics, and individual hospital practices were collected. The primary outcome was PRD timing (hours from admission or emergency department [ED] presentation until the first 4-hour albuterol spacing). RESULTS: Data for 1005 participants were available (865 ED presentations). Several nonstandard care practices were associated with time to PRD (P < .001). Continuous pulse oximetry was associated with increased time to PRD (P = .004). ED dexamethasone administration was associated with decreased time to PRD (P < .001) and less ICU admittance and intravenous steroid use (P < .0001). Earlier receipt of chest radiograph, antibiotics, and intravenous steroids was associated with shorter time to PRD (P < .05). Care practices associated with shorter time to PRD varied markedly by hospital. CONCLUSIONS: Substantial variation in care practices for inpatient asthma treatment exists among children's hospital systems in Ohio. We found several modifiable, system-level factors and therapies that contribute to PRD that warrant further investigation to identify the best and safest care practices. We also found that there was no standardized measure of exacerbation severity used across the hospitals. The development of such a tool is a critical gap in current practice and is needed to enable definitive comparative effectiveness studies of the management of acute asthma exacerbation.
BACKGROUND: Large-scale, multisite studies in which researchers evaluate patient- and systems-level factors associated with pediatric asthma exacerbation outcomes are lacking. We sought to investigate patient-level risks and system-level practices related to physiologic readiness for discharge (PRD) in the prospective Ohio Pediatric Asthma Repository. METHODS:Participants were children ages 2 to 17 years admitted to an Ohio Pediatric Asthma Repository hospital for asthma exacerbation. Demographics, disease characteristics, and individual hospital practices were collected. The primary outcome was PRD timing (hours from admission or emergency department [ED] presentation until the first 4-hour albuterol spacing). RESULTS: Data for 1005 participants were available (865 ED presentations). Several nonstandard care practices were associated with time to PRD (P < .001). Continuous pulse oximetry was associated with increased time to PRD (P = .004). ED dexamethasone administration was associated with decreased time to PRD (P < .001) and less ICU admittance and intravenous steroid use (P < .0001). Earlier receipt of chest radiograph, antibiotics, and intravenous steroids was associated with shorter time to PRD (P < .05). Care practices associated with shorter time to PRD varied markedly by hospital. CONCLUSIONS: Substantial variation in care practices for inpatient asthma treatment exists among children's hospital systems in Ohio. We found several modifiable, system-level factors and therapies that contribute to PRD that warrant further investigation to identify the best and safest care practices. We also found that there was no standardized measure of exacerbation severity used across the hospitals. The development of such a tool is a critical gap in current practice and is needed to enable definitive comparative effectiveness studies of the management of acute asthma exacerbation.
Authors: Trudy B Pendergraft; Richard H Stanford; Richard Beasley; David A Stempel; Craig Roberts; Trent McLaughlin Journal: Ann Allergy Asthma Immunol Date: 2004-07 Impact factor: 6.347