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A Prospective Multicenter Study of Patient Factors Associated With Hospital Admission From the Emergency Department Among Children With Acute Asthma
Charles V. Pollack, Jr, MA, MD;
Emily S. Pollack, MD;
Jill M. Baren, MD;
Sharon R. Smith, MD;
Prescott G. Woodruff, MD, MPH;
Sunday Clark, MPH;
Carlos A. Camargo, MD, DrPH;
for the Multicenter Airway Research Collaboration Investigators
Arch Pediatr Adolesc Med. 2002;156:934-940.
Background Recent studies show that objective measures such as peak flow rates
are strongly associated with asthma admission among adults.
Objective To identify factors associated with admission among children.
Methods We performed a prospective cohort study as part of the Multicenter Airway
Research Collaboration. Patients aged 2 to 17 years who presented to the emergency
department (ED) with acute asthma underwent a structured interview in the
ED and another by telephone 2 weeks later. The study was performed at 44 EDs
in 18 US states and 4 Canadian provinces. The decision to admit was made at
the discretion of the treating physician. Univariate analysis of risk factors
for admission was followed by multivariate logistic regression.
Results Of the 1178 eligible subjects, 275 (23%; 95% confidence interval, 21%-26%)
were admitted or placed into ED observation units. A multivariate model that
included 12 characteristics measured at presentation and during the ED stay
was associated with an area under the receiver operating characteristic curve
of 0.91. Demographic factors were not independently associated with admission.
Severity of symptoms (odds ratio, 1.3) and intensity of therapy both before
and during ED visit correlated with the likelihood of admission. Previous
admission for asthma (P = .02) and recent use of
inhaled corticosteroids (P = .04) also were associated
with admission. Peak flows were associated with admission but were infrequently
(23% overall) measured.
Conclusion Hospitalization for asthma exacerbation in children is primarily associated
with clinical indicators in the ED and with historical factors such as previous
asthma admission or intubation, recent use of corticosteroids, and comorbidity.
From the Departments of Emergency Medicine, Pennsylvania Hospital,
Philadelphia (Drs C. V. Pollack and E. S. Pollack), Children's Hospital of
Philadelphia (Dr Baren), Washington University School of Medicine, St Louis,
Mo (Dr Smith), and Massachusetts General Hospital and Channing Laboratory,
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School,
Boston, Mass (Drs Woodruff and Camargo and Ms Clark).
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