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Aguilar R, Knudsen-Robbins C, Ehwerhemuepha L, Feaster W, Kamath S, Heyming TW. Pediatric Asthma Exacerbations: 14-Day Emergency Department Return Visit Risk Factors. J Emerg Med 2024; 67:e22-e30. [PMID: 38824038 DOI: 10.1016/j.jemermed.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/10/2024] [Accepted: 02/02/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Asthma, the most common chronic disease of childhood, can affect a child's physical and mental health and social and emotional development. OBJECTIVE The aim of this study was to identify factors associated with emergency department (ED) return visits for asthma exacerbations within 14 days of an initial visit. METHODS This was a retrospective review from Cerner Real-World Data for patients aged from 5 to 18 years and seen at an ED for an asthma exacerbation and discharged home at the index ED visit. Asthma visits were defined as encounters in which a patient was diagnosed with asthma and a beta agonist, anticholinergic, or systemic steroid was ordered or prescribed at that encounter. Return visits were ED visits for asthma within 14 days of an index ED visit. Data, including demographic characteristics, ED evaluation and treatment, health care utilization, and medical history, were collected. Data were analyzed via logistic regression mixed effects model. RESULTS A total of 80,434 index visits and 17,443 return visits met inclusion criteria. Prior ED return visits in the past year were associated with increased odds of a return visit (odds ratio [OR] 2.12; 95% CI 2.07-2.16). History of pneumonia, a concomitant diagnosis of pneumonia, and fever were associated with increased odds of a return visit (OR 1.19; 95% CI 1.10-1.29; OR 1.15; 95% CI 1.04-1.28; OR 1.20; 95% CI 1.11-1.30, respectively). CONCLUSIONS Several variables seem to be associated with statistically significant increased odds of ED return visits. These findings indicate a potentially identifiable population of at-risk patients who may benefit from additional evaluation, planning, or education prior to discharge.
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Affiliation(s)
- Ricardo Aguilar
- Research Computational and Data Science, Research Institute, Children's Hospital of Orange County, Orange, California
| | - Chloe Knudsen-Robbins
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Louis Ehwerhemuepha
- Research Computational and Data Science, Research Institute, Children's Hospital of Orange County, Orange, California; School of Computational and Data Sciences, Chapman University, Orange, California
| | | | - Sunil Kamath
- Children's Hospital of Orange County, Orange, California
| | - Theodore W Heyming
- Children's Hospital of Orange County, Orange, California; Department of Emergency Medicine, University of California, Irvine, Orange, California.
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Adatia A, Moolji J, Satia I. Acuity of asthma exacerbations in Alberta, Canada is increasing: a population-based study. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2024; 20:13. [PMID: 38347595 PMCID: PMC10863092 DOI: 10.1186/s13223-024-00872-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/01/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Asthma is a common respiratory illness affecting 2.8 million Canadians, including 9.7% of Albertans. Prior studies showed a substantial decrease in ED visits for asthma in the decade preceding 2010, followed by a stabilization. This was attributed to improvements in the pharmacologic and non-pharmacologic treatments for asthma during that period followed by a balance between epidemiologic drivers and protective factors in the population. METHODS We assessed whether this trend continued in Alberta from 2010 to 2022 using population level data for the volume of daily ED visits, acuity of asthma exacerbations in the ED, and hospitalization rate. RESULTS The mean number of ED visits decreased from 4.5 to 2.2 per million persons per day, but the acuity of exacerbations and the proportion requiring hospitalization increased. The number of patients presenting with the highest level of acuity increased by over 300%, and the percentage of patients requiring hospitalization increased from 6.8 to 11.3%. CONCLUSION Total ED visits for asthma exacerbations continues to decline in Alberta. The reasons for an increase in more severe exacerbations requires further attention.
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Affiliation(s)
- Adil Adatia
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
- Alberta Respiratory Centre, Edmonton, AB, Canada.
| | - Jalal Moolji
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Imran Satia
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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Gonzalez-Uribe V, Navarrete-Rodríguez EM, Angeles-Tellez FS, Montiel-Gonzalez JA, Colin-Rubio J, Gonzalez-Chavarria CF, Mojica-Gonzalez ZS. Asthma exacerbations in the pediatric emergency area: Evaluation and prospects for improvement of pre-hospital care. Allergol Immunopathol (Madr) 2023; 51:37-44. [PMID: 37937494 DOI: 10.15586/aei.v51i6.909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/06/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION The frequency of visits to emergency department for asthma is a significant public health problem in pediatrics. This study aimed to identify the characteristics of children who visited the pediatric emergency department for asthma exacerbation and evaluated their therapeutic management prior to admission. METHODS A prospective study was conducted over a 6-month period in the pediatric emergency departments of five hospitals involving children aged 1-16 years admitted to the department with a clinical diagnosis of asthma exacerbation. RESULTS In all, 143 patients were enrolled in the study. Asthma episodes were moderate to severe in 69.2% of cases (n = 99). Initial treatment prior to admission to the emergency department was adequate in only 17.5% of cases (n = 25). Hospitalization for more than 24 h occurred in 18.2% (n = 26) patients. In children aged <3 years, viral infection was present in 91.4% cases (n = 64) and exacerbations were more severe in younger patients (P = 0.002) and children belonging to low-income stratum (P = 0.025). Only 17.4% (n = 25) were positive for SARS-CoV-2 (antigen test or polymerase chain reaction test), suggesting that the involvement of traditional respiratory viruses in asthma exacerbation continued even during pandemic. Regarding the pre-hospital care, 70.6% (n = 101) had received prior treatment, but this treatment was inadequate in 53.1% cases (n = 76). CONCLUSION This study showed that asthmatic children and their families had little knowledge about the disease and that physicians must be sufficiently aware of current recommendations for managing asthmatic children. Admission to the emergency department for asthma could be avoided partially by better diagnosis and therapeutic education.
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Affiliation(s)
- Victor Gonzalez-Uribe
- Facultad Mexicana de Medicina, Universidad La Salle Mexico, Mexico City, Mexico
- Servicio de Alergia e Inmunología, Hospital Infantil de México Federico Gomez, Mexico City, Mexico;
| | | | | | | | - Jorge Colin-Rubio
- Facultad Mexicana de Medicina, Universidad La Salle Mexico, Mexico City, Mexico
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Mayers I, Randhawa A, Qian C, Talukdar M, Soliman M, Jayasingh P, Johnston K, Bhutani M. Asthma-related emergency admissions and associated healthcare resource use in Alberta, Canada. BMJ Open Respir Res 2023; 10:e001934. [PMID: 37914234 PMCID: PMC10668303 DOI: 10.1136/bmjresp-2023-001934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/06/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND There is a lack of real-world research assessing asthma management following asthma-related emergency department (ED) discharges. The objective of this study was to characterise follow-up care, healthcare resource use (HCRU) and medical costs following ED admissions in Alberta, Canada. METHODS A retrospective cohort study was conducted on adults with asthma using longitudinal population-based administrative data from Alberta Health Services. Adult patients with asthma and ≥1 ED admission from 1 April 2015 to 31 March 2020 were included. ED admissions, outpatient visits, hospitalisations and asthma-specific medication use were measured in the 30 days before and up to 90 days after each asthma-related ED admission. Mean medical costs attributable to each type of HCRU were summarised. All outcomes were stratified by patient baseline disease severity. RESULTS Among 128 063 patients incurring a total of 20 142 asthma-related ED visits, a substantial rate of ED readmission was observed, with 10% resulting in readmissions within 7 days and 35% within 90 days. Rates increased with baseline asthma severity. Despite recommendations for patients to be followed up with an outpatient visit within 2-7 days of ED discharge, only 6% were followed up within 7 days. The mean total medical cost per patient was $C8143 in the 30 days prior to and $C5407 in the 30 days after an ED admission. CONCLUSIONS Despite recommendations regarding follow-up care for patients after asthma-related ED admissions, there are still low rates of outpatient follow-up visits and high ED readmission rates. New or improved multidimensional approaches must be integrated into follow-up care to optimise asthma control and prevent readmissions.
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Affiliation(s)
- Irvin Mayers
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Arsh Randhawa
- AstraZeneca Canada Inc, Mississauga, Ontario, Canada
| | | | | | - Mena Soliman
- AstraZeneca Canada Inc, Mississauga, Ontario, Canada
| | | | | | - Mohit Bhutani
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Sposato B, Petrucci E, Lacerenza GL, Micheletto C, Montagnani A, Alessandri M, Cresti A, Serafini A, Lena F, Scala R, Rogliani P, Perrella A, Scalese M. Sex differences in excessive oral corticosteroid exposure in poor adherent adult asthmatics overusing short-acting β-2 agonists. Minerva Med 2023; 114:642-651. [PMID: 34269554 DOI: 10.23736/s0026-4806.21.07645-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We know that excessive short-acting β2-agonists (SABA) use in asthma may be associated to high exacerbation risks. We studied whether such excessive SABA consumption is connected with different higher oral corticosteroid (OC) prescriptions in the two sexes. METHODS In our prescribing database, we searched subjects aged 18-40 years that were prescribed at least one SABA package/year and/or at least two ICS or two ICS/LABA boxes/year to identify asthmatics. Their OC prescriptions/year were also examined. Subjects were divided into 4 groups according to SABA packages/year prescribed (0, 1-2,3-6 and ≥7), considering sexes separately. RESULTS Individuals recruited were 9,102. Subjects with at least one OC prescription were higher in each group and were females (P<0.001). The OC packages/year number was also more elevated in women especially those with >7 SABA prescriptions/year (0.96 in males vs. 2.64 in females, P<0.001). 94.7%/93.6% males/females, who never used SABA, took at least one ICS/LABA (mean 5.84/5.48 packages/year), while the subject percentage adhering to ICS/LABA dropped to 28-47% (mean 0.94-3.82 packages/year) in those who used SABA (P<0.001). Higher SABA prescriptions were associated with an increasing OC dispensation (β=0.057, P<0.0001). We observed also a greater risk of using >3 OC packages/year in subjects with 3-6 (OR: 2.98 [95% CI: 2.19-4.06], P<0.001) and ≥7 (OR: 3.49 [95% CI: 2.39-5.10], P<0.001) SABA prescriptions compared to those that never used SABA. Besides, we found that using ICS (OR:0.51 [95% CI: 0.35-0.75], P<0.001) or ICS/LABA (OR:0.07 [95% CI: 0.05-0.09], P<0.001) may significantly reduce SABA prescriptions. CONCLUSIONS Poor adherence to maintenance treatment appears to associated with excessive SABA prescriptions that may lead to a higher OC consumption particularly noticeable in women.
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Affiliation(s)
- Bruno Sposato
- Department of Pneumology, Misericordia Hospital, Azienda USL Toscana Sud-Est, Grosseto, Italy -
- Experimental Medicine and Systems, Department of Systems Medicine, Tor Vergata University, Rome, Italy -
| | - Elisa Petrucci
- Unit of Local Health, Pharmaceutical Department, USL Toscana Sud Est, Grosseto, Italy
| | - Gianluca L Lacerenza
- Unit of Local Health, Pharmaceutical Department, USL Toscana Sud Est, Grosseto, Italy
| | - Claudio Micheletto
- Respiratory Unit, Cardio-Thoracic Department, Integrated University Hospital, Verona, Italy
| | - Andrea Montagnani
- Department of Internal Medicine and Specialties, USL Tuscany South-East, Grosseto, Italy
| | - Massimo Alessandri
- Department of Internal Medicine and Specialties, USL Tuscany South-East, Grosseto, Italy
| | - Alberto Cresti
- Department of Cardiology, Misericordia Hospital, USL Tuscany South-East, Grosseto, Italy
| | - Andrea Serafini
- Department Medical Management, Misericordia Hospital, Azienda USL Toscana Sud-Est, Grosseto, Italy
| | - Fabio Lena
- Unit of Local Health, Pharmaceutical Department, USL Toscana Sud Est, Grosseto, Italy
| | - Raffaele Scala
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy
| | - Paola Rogliani
- Respiratory Unit, Department of Experimental Medicine, Tor Vergata University, Rome, Italy
| | - Antonio Perrella
- Department of Pneumology, Misericordia Hospital, Azienda USL Toscana Sud-Est, Grosseto, Italy
| | - Marco Scalese
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
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Shechter J, Roy A, Naureckas S, Estabrook C, Mohanty N. Variables Associated with Emergency Department Utilization by Pediatric Patients with Asthma in a Federally Qualified Health Center. J Community Health 2020; 44:948-953. [PMID: 30905027 DOI: 10.1007/s10900-019-00653-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To study variables associated with Emergency Department (ED) utilization among pediatric patients with asthma in a Federally Qualified Health Center (FQHC). We analyzed Electronic Health Record (EHR) data in a retrospective cohort study of patients with asthma between ages 2 and 18 who received primary care at a FQHC. The primary outcome studied was a visit to the ED at Ann and Robert Lurie's Children's Hospital (LCH) for an acute visit related to asthma. Univariate analyses and a multiple logistic regression were performed to study the effect of demographic and clinical variables on ED utilization. Of the 286 patients in the initial EHR query, 200 were included in the final analysis. The median age of subjects in the study cohort was 8.73 years. Patients in the cohort with ED visits averaged 1.32 ED visits in the 15-month period of analysis. The multivariable logistic regression model demonstrated the significant predictors of ED utilization were (1) younger age (OR 0.977, 0.968-0.984, P < 0.001), (2) proximity of patient residence to the hospital when compared with their primary care medical home (OR 0.907, 95% CI 0.828-0.992, P < 0.05), and (3) absence of an asthma action plan (OR 0.079, 95% CI, 0.016-0.283, P < 0.001). Younger age, closer relative proximity of the patient's home to the hospital compared with the clinic, and absence of an asthma action plan were all identified as significant predictors of ED utilization. Sex, ethnicity, language, passive smoke exposure, and insurance status were not statistically significant predictors of ED utilization.
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Affiliation(s)
- Jesse Shechter
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA.
| | - Angkana Roy
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
| | - Sara Naureckas
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
| | - Christopher Estabrook
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
| | - Nivedita Mohanty
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA.,AllianceChicago, 215 W Ohio St, Chicago, IL, 60654, USA
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