Factors associated with future hospitalization among children with asthma: a systematic review

Predicting Future Acute Care Visit Risk in Kids With Asthma (PARKA): A Nested Cohort Study

OBJECTIVES

We aimed to develop a clinical risk score to predict future asthma acute care visits [emergency department (ED) visits or hospitalizations] within 1 year following a discharge from 1 of 2 tertiary care pediatric EDs in Ontario, Canada.

METHODS

We assembled a nested Ontario cohort from the multicenter prospective DOORWAY cohort study and included children 1 to 17 years of age, with an ED visit for a moderate/severe asthma exacerbation. We linked this with provincial health administrative data. We used multivariable regression to derive and internally validate a practical clinical risk score to predict future asthma acute care visits.

RESULTS

A total of 257 children [32% female, median age 3.0 years (IQR 1 to 7 y)] were included, and 58 experienced an asthma visit within the following year. These were best predicted by 4 factors: food allergy (OR 4.2, 95% CI: 1.2-14.9), family history of asthma (OR 0.5, 95% CI: 0.3-0.9), prior acute asthma medical visits (OR 2.8, 95% CI: 0.9-8.6), and prior emergency room visits for any respiratory diagnosis (OR 3.0, 95% CI: 1.4-6.4). A score of 0, 1, or 2 points was applied to each factor for up to a maximum of 6 points; the PARKA score has very good overall performance with a scaled Brier score of 0.11 on internal validation and good discrimination with an AUC of 0.72 (95% CI: 0.64-0.78).

CONCLUSIONS

The PARKA score predicts the risk of a future asthma acute care visit in a cohort of Ontario children with a moderate/severe asthma ED visit. Following external validation, this tool may aid ED clinicians in accurately targeting resource-intensive preventative interventions for at-risk children.

Effect of game-based asthma management interventions on pediatric asthma control, knowledge, attitudes, hospitalizations, and emergency visits: A systematic review and meta-analysis

PURPOSE

Many studies have used game-based interventions to educate children about asthma. The study aims to determine the effectiveness of these games in improving asthma control and related outcomes in children.

METHODS

Seven databases were searched: PubMed, Cochrane Library, Scopus, CINAHL, Embase, Web of Science, and PsycINFO'. All research papers published until June 2023 were included. MeSH terms and keywords were used in the literature search. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instruments was used to assess the risk of bias.

RESULTS

This systematic review and meta-analysis included nine studies with a total sample size of 694 children. The effect size for hospitalization rates was not statistically significant (p > 0.05), although the association was significant (p = 0.004). Conversely, a statistically significant reduction in emergency visits was observed (p < 0.05), with an effect size estimate of 0.376. The analysis also revealed a significant improvement in asthma knowledge (p < 0.05), with an effect size estimate of 0.677 (95 % CI: 0.240 to 1.114, p = 0.002), and an increase in asthma control (p < 0.05), although the association was not statistically significant (p = 0.120) with an effect size estimate of 0.169 (95 % CI: -0.044 to 0.381). Conversely, no statistically significant effect was observed for asthma attitude (p > 0.05).

CONCLUSION

Game-based interventions have shown promise in improving asthma management in children by enhancing knowledge and control and reducing emergency visits. This approach is increasingly recommended in clinical settings, though there is notable heterogeneity in study design and participant demographics.

A real-world evaluation of the effectiveness and Sufficiency of Current Emergency Department Preventative Strategies for Reducing Emergency Department revisits in a Canadian children's hospital: a retrospective cohort study

BACKGROUND

Despite asthma guidelines' recommended emergency department preventative strategies (EDPS), repeat asthma-related emergency department (ED) visits remain frequent.

METHODS

We performed a retrospective cohort study of children aged 1-17 years presenting with asthma to the Children's Hospital of Eastern Ontario (CHEO) ED between September 1, 2014 - August 31, 2015. EDPS was defined as provision of education on trigger avoidance and medication technique plus documentation of an asthma action plan, a prescription for an inhaled controller medication or referral to a specialist. Logistic regression was used to identify factors associated with receipt of EDPS. We further compared the odds of repeat presentation to the ED within the following year among children who had received EDPS versus those who had not.

RESULTS

1301 patients were included, and the mean age of those who received EDPS was 5.0 years (SD = 3.7). Those with a moderate (OR = 3.67, 95% CI: 2.49, 5.52) to severe (OR = 3.69, 95% CI: 2.50, 5.45) asthma presentation were most likely to receive EDPS. Receiving EDPS did not significantly reduce the adjusted odds of repeat ED visits, (OR = 0.82, 95% CI: 0.56, 1.18, p = 0.28).

CONCLUSIONS

Patients with higher severity asthma presentations to the ED were more likely to receive EDPS, but this did not appear to significantly decrease the proportion with a repeat asthma ED visit. These findings suggest that receipt of EDPS in the ED may not be sufficient to prevent repeat asthma ED visits in all children.

Investigating Machine Learning Techniques for Predicting Risk of Asthma Exacerbations: A Systematic Review

Asthma, a common chronic respiratory disease among children and adults, affects more than 200 million people worldwide and causes about 450,000 deaths each year. Machine learning is increasingly applied in healthcare to assist health practitioners in decision-making. In asthma management, machine learning excels in performing well-defined tasks, such as diagnosis, prediction, medication, and management. However, there remain uncertainties about how machine learning can be applied to predict asthma exacerbation. This study aimed to systematically review recent applications of machine learning techniques in predicting the risk of asthma attacks to assist asthma control and management. A total of 860 studies were initially identified from five databases. After the screening and full-text review, 20 studies were selected for inclusion in this review. The review considered recent studies published from January 2010 to February 2023. The 20 studies used machine learning techniques to support future asthma risk prediction by using various data sources such as clinical, medical, biological, and socio-demographic data sources, as well as environmental and meteorological data. While some studies considered prediction as a category, other studies predicted the probability of exacerbation. Only a group of studies applied prediction windows. The paper proposes a conceptual model to summarise how machine learning and available data sources can be leveraged to produce effective models for the early detection of asthma attacks. The review also generated a list of data sources that other researchers may use in similar work. Furthermore, we present opportunities for further research and the limitations of the preceding studies.

Risk factors for asthma-related hospital and intensive care admissions in children, adolescents and adults: a cohort study using primary and secondary care data

BACKGROUND

Asthma remains a common cause of hospital admissions across the life course. We estimated the contribution of key risk factors to asthma-related hospital and intensive care unit (ICU) admissions in children, adolescents and adults.

METHODS

This was a UK-based cohort study using linked primary care (Clinical Practice Research Datalink Aurum) and secondary care (Hospital Episode Statistics Admitted Patient Care) data. Patients were eligible if they were aged 5 years and older and had been diagnosed with asthma. This included 90 989 children aged 5-11 years, 114 927 adolescents aged 12-17 years and 1 179 410 adults aged 18 years or older. The primary outcome was asthma-related hospital admissions from 1 January 2017 to 31 December 2019. The secondary outcome was asthma-related ICU admissions. Incidence rate ratios adjusted for demographic and clinical risk factors were estimated using negative binomial models. Population attributable fraction (PAF) was estimated for modifiable risk factors.

RESULTS

Younger age groups, females and those from ethnic minority and lower socioeconomic backgrounds had an increased risk of asthma-related hospital admissions. Increasing medication burden, including excessive use of short-acting bronchodilators, was also strongly associated with the primary outcome. Similar risk factors were observed for asthma-related ICU admissions. The key potentially modifiable or treatable risk factors were smoking in adolescents and adults (PAF 6.8%, 95% CI 0.9% to 12.3% and 4.3%, 95% CI 3.0% to 5.7%, respectively), and obesity (PAF 23.3%, 95% CI 20.5% to 26.1%), depression (11.1%, 95% CI 9.1% to 13.1%), gastro-oesophageal reflux disease (2.3%, 95% CI 1.2% to 3.4%), anxiety (2.0%, 95% CI 0.5% to 3.6%) and chronic rhinosinusitis (0.8%, 95% CI 0.3% to 1.3%) in adults.

CONCLUSIONS

There are significant sociodemographic inequalities in the rates of asthma-related hospital and ICU admissions. Treating age-specific modifiable risk factors should be considered an integral part of asthma management, which could potentially reduce the rate of avoidable hospital admissions.

Predictive Factors of Hospitalization and Emergency Visits Among Children With Asthma

Introduction A chronic diverse inflammatory disease, asthma affects millions of people worldwide. To control asthma, standardized care is essential. Children with asthma who receive appropriate care have lower emergency room (ER) visits and hospital stays as well as a higher quality of life than children who do not receive appropriate care. We aim to evaluate the predictive variables of hospitalization and ER visits in children with asthma. Methodology In 2022 and 2023, a cross-sectional descriptive study was carried out on children with asthma and their caregivers who were attending primary health care clinics in the eastern region of Saudi Arabia. We used the Childhood Asthma Control Test (C-ACT) to evaluate asthma control. A C-ACT score of less than 19 indicates uncontrolled childhood asthma. To investigate the relationships between the risk factors and the rate of ER visits and hospitalizations, we performed a multiple logistic descriptive analysis. Results In this study, 124 asthmatic children from primary health care centers matched the inclusion criteria. The majority of children had atopy, and their mean age was 10.8±3.4 years. Concerning the risk factors linked to ER visits and hospitalization, there is evidence that not following up with physicians, using more frequent and short-acting beta-agonists, exposure to smoke and household pets, and poor asthma control are linked to increased rates of both ER visits and hospitalizations. Conclusion Better asthma control in children and adolescents may be achieved by providing inexpensive asthma care services, more thorough parental and child education, and effective symptom management. These measures can help reduce exacerbations of asthma and the consequences that accompany them.

Asthma-related emergency admissions and associated healthcare resource use in Alberta, Canada

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.