Children's emergency department use for asthma, 2001-2010

Abstract

Objectives: Although the emergency department (ED) provides essential care for severely ill or injured children, past research has shown that children often visit the ED for potentially preventable illnesses, including asthma. We sought to determine how children's rate of ED visits for asthma has changed over the last decade and to analyze what factors are associated with a child's potentially preventable ED visit for asthma.

Methods: We retrospectively analyzed ED visits by children aged 2 to 17 from 2001 to 2010 using data from the National Hospital Ambulatory Medical Care Survey. Visits were classified as potentially preventable asthma visits by mapping ICD-9-CM diagnosis codes to the Agency for Healthcare Research and Quality's asthma pediatric quality indicator. We examined trends in the annual rate of ED visits for asthma per 1000 children using a weighted linear regression model. Finally, we used multivariate logistic regression to determine what demographic, clinical, and structural factors were associated with a child's ED visit being for a potentially preventable asthma crisis.

Results: The rate of children's ED visits for asthma increased 13.3% between 2001 and 2010, from 8.2 to 9.3 visits per 1000 children (P = .26). ED visits by children who were younger, male, racial or ethnic minorities, insured with Medicaid/Children's Health Insurance Program, and visiting between 11 pm and 7 am were more likely to be for potentially preventable asthma crises.

Conclusions: Although the overall rate of potentially preventable ED visits for asthma did not significantly change over the last decade, racial, insurance-based, and other demographic disparities in the likelihood of a preventable asthma-related ED visit persist.

Keywords: National Hospital Ambulatory Medical Care Survey; asthma; emergency department utilization.

Figure 1

Rates ED visits for potentially preventable asthma and non- potentially preventable asthma diagnoses by children ages 2–17, 2001–2010 Legend: Though ED visit rates for potentially preventable asthma diagnoses (blue line) rose from 8.2 per 1000 children in 2001 to 9.3 per 1000 in 2010 (13.3%) and other diagnoses (red line) diagnoses rose from 293 to 323 per 1000 (11.9%), there were many fluctuations and neither was statistically significant (p = 0.26 and 0.16, respectively).