Factors associated with prolonged hospitalization of children with asthma
B. Morray and G. Redding
Department of Pediatrics, University of Washington School of Medicine, Seattle.
OBJECTIVE: To identify clinical features of asthma present before arrival
in the emergency department, at the time of emergency department treatment,
and during hospitalization that differ between children with asthma
hospitalized for a prolonged period and those hospitalized for an average
duration. DESIGN: Retrospective chart review. PATIENTS AND SETTING:
Hospital records of patients with asthma (International Classification of
Diseases, Ninth Revision, code 493) admitted to Children's Hospital and
Medical Center, Seattle, Wash, from October 1989 to September 1991.
RESULTS: The medical records of 23 children hospitalized from October 1989
to September 1991 for more than 4 days with acute asthma were compared with
those of 62 sex- and age-matched children hospitalized for 2 days. Patients
in the long-stay and short-stay groups had similar histories of home
medication use. The presence of asthma symptoms before arrival in the
emergency department was prolonged in the long-stay group (P < .001).
Only one of the 23 patients in the long-stay group had augmented asthma
treatment within 24 hours before hospitalization, compared with 39 of the
62 patients with short stays (P < .001). During hospitalization, a
greater proportion of children in the long-stay group than the short-stay
group received supplemental oxygen (P < .01). More children in the
long-stay group than the short-stay group had residual hypoxemia (arterial
oxygen saturation, < 94%) in room air at discharge, suggesting that
hospital stay was not prolonged to reach normal oxygen saturations. None of
the children were readmitted within 1 month of their index admission.
CONCLUSIONS: Early augmentation of home therapy for acute asthma is
associated with a reduced duration of hospitalization for children admitted
with asthma. In addition, hypoxemia in children with acute asthma on
presentation and during hospitalization is associated with prolonged
hospital stay.
