Predictors of repeated acute hospital attendance for asthma in children: A systematic review and meta-analysis

Abstract

Background: Asthma attacks are common and have significant physical, psychological, and financial consequences. Improving the assessment of a child's risk of subsequent asthma attacks could support front-line clinicians' decisions on augmenting chronic treatment or specialist referral. We aimed to identify predictors for emergency department (ED) or hospital readmission for asthma from the published literature.

Methods: We searched MEDLINE, EMBASE, AMED, PsycINFO, and CINAHL with no language, location, or time restrictions. We retrieved observational studies and randomized controlled trials (RCT) assessing factors (personal and family history, and biomarkers) associated with the risk of ED re-attendance or hospital readmission for acute childhood asthma.

Results: Three RCTs and 33 observational studies were included, 31 from Anglophone countries and none from Asia or Africa. There was an unclear or high risk of bias in 14 of the studies, including 2 of the RCTs. Previous history of emergency or hospital admissions for asthma, younger age, African-American ethnicity, and low socioeconomic status increased risk of subsequent ED and hospital readmissions for acute asthma. Female sex and concomitant allergic diseases also predicted hospital readmission.

Conclusion: Despite the global importance of this issue, there are relatively few high quality studies or studies from outside North America. Factors other than symptoms are associated with the risk of emergency re-attendance for acute asthma among children. Further research is required to better quantify the risk of future attacks and to assess the role of commonly used biomarkers.

Keywords: asthma attacks; emergency department; future risk; hospital admission; paediatric asthma.

Figure 1

Flow diagram of included and excluded studies

Figure 2

Forest plots for the association of sex with emergency department re‐attendance and hospital readmission for acute asthma in children using a random effects model. (Figure 2A‐2D showing separate estimations for odds and hazard ratios)

Figure 3

Forest plots for the associations of ethnicity (black vs other) with emergency department re‐attendance and hospital readmission for acute asthma in children using a random effects model

Figure 4

Forest plots for the associations of socioeconomic status (SES) with emergency department re‐attendance and hospital readmission for acute asthma in children using a random effects model

Figure 5

Forest plots for the associations of previous ED or hospital admissions for acute asthma with emergency department re‐attendance and hospital readmission for acute asthma in children using a random effects model