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Multicenter Study
. 2018 Jun;8(6):305-313.
doi: 10.1542/hpeds.2017-0085. Epub 2018 May 15.

Ohio Pediatric Asthma Repository: Opportunities to Revise Care Practices to Decrease Time to Physiologic Readiness for Discharge

Jeffrey M Simmons  1   2 , Jocelyn M Biagini Myers  3   2 , Lisa J Martin  4   2 , Carolyn M Kercsmar  5   2 , Christine L Schuler  1   2 , Valentina V Pilipenko  4 , John W Kroner  3 , Hua He  4 , Stephen R Austin  3 , Huyen-Tran Nguyen  3 , Kristie R Ross  6 , Karen S McCoy  7 , Sherman J Alter  8 , Samantha M Gunkelman  9 , Pierre A Vauthy  10 , Gurjit K Khurana Hershey  11   2
Affiliations
Multicenter Study

Ohio Pediatric Asthma Repository: Opportunities to Revise Care Practices to Decrease Time to Physiologic Readiness for Discharge

Jeffrey M Simmons et al. Hosp Pediatr. 2018 Jun.

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.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr Kercsmar reports personal fees from GlaxoSmithKline outside the submitted work; the other authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Subject identification and PRD definitions.
FIGURE 2
FIGURE 2
Demographic, severity indicator practices, and IP practices are associated with PRDIP in a multivariable model. LSM, least square mean; RT, respiratory therapist. * P < .05; ** P < .01; *** P < .001.
FIGURE 3
FIGURE 3
ED practices and time-dependent practices associated with PRDTOT in a multivariate model. LSM, xxx. * P < .05; ** P < .01; *** P < .001.
FIGURE 4
FIGURE 4
Variation in timing to PRD by hospital is partially explained by demographics, exacerbation severity, and IP and ED practices. * P < .05; ** P < .01; *** P < .001.
See this image and copyright information in PMC

References

    1. Akinbami LJ, Moorman JE, Liu X. Asthma prevalence, health care use, and mortality: United States, 2005–2009. Natl Health Stat Rep. 2011;(32):1–14 - PubMed
    1. Hasegawa K, Tsugawa Y, Brown DF, Camargo CA Jr. Childhood asthma hospitalizations in the United States, 2000–2009. J Pediatr. 2013;163(4):1127–1133.e3 - PMC - PubMed
    1. Wazeka A, Valacer DJ, Cooper M, Caplan DW, DiMaio M. Impact of a pediatric asthma clinical pathway on hospital cost and length of stay. Pediatr Pulmonol. 2001;32(3):211–216 - PubMed
    1. Shanley LA, Lin H, Flores G. Factors associated with length of stay for pediatric asthma hospitalizations. J Asthma. 2015;52(5):471–477 - PubMed
    1. Rowe BH, Bretzlaff JA, Bourdon C, Bota GW, Camargo CA Jr. Intravenous magnesium sulfate treatment for acute asthma in the emergency department: a systematic review of the literature. Ann Emerg Med. 2000;36(3):181–190 - PubMed

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