Reznik M, Hailpern SM, Ozuah PO. J Asthma. 2006;43:37–40
PURPOSE OF THE STUDY. To identify modifiable predictors of early readmission in inner-city children with asthma.
STUDY POPULATION. All pediatric patients aged 0 to 21 years who were discharged with a primary diagnosis of asthma during the study period were identified from a single hospital. Case patients were those who were readmitted with asthma within 30 days of discharge, and controls were those who were not readmitted. A total of 152 case patients and 293 controls who met the inclusion criteria were used in this study.
METHODS. Medical chart reviews were performed on the selected patients. Information was collected on demographics, variables related to past asthma history, variables related to the index admission, and variables related to discharge from the index admission. The data were evaluated by using conditional logistic regression analyses.
RESULTS. Case patients were more likely to have been hospitalized for asthma in the past 12 months (odds ratio [OR]: 2.22; 95% confidence interval [CI]: 1.40–3.50), to have visited the emergency department for asthma in the past 12 months (OR: 3.28; 95% CI: 1.55–6.94), to have a history of an ICU admission for asthma (OR: 1.87; 95% CI: 1.26–3.78), to have received a pulmonary consultation during the index admission (OR: 1.87; 95% CI: 1.12–3.10), and to have been prescribed inhaled corticosteroids before the index admission (OR: 1.61; 95% CI: 1.02–2.52). Multivariate analysis revealed that a history of asthma hospitalization within the past 12 months was an independent predictor of early readmission (OR: 1.89; P = .021).
CONCLUSIONS. A history of asthma hospitalization within the past 12 months was associated with early readmission. Modifiable factors such as medical treatment and management during and at discharge from the index admission did not predict early asthma readmission.
REVIEWER COMMENTS. In this largely minority population, with >50% covered by Medicaid, early readmission was increased in those with markers of more severe and persistent asthma. History of an asthma-related emergency department visit in the last year, ICU admission for asthma, or pulmonary consultation was associated with readmission. Children with a prescription for inhaled corticosteroid (ICS) before hospitalization were more likely to require readmission, yet no protective effect was identified for ICS prescription at the time of discharge. On multivariate analysis, early readmission was associated with hospitalization for asthma in the preceding 12 months. Although limited by its retrospective nature, this study indicates that children who frequently use tertiary care for asthma are at increased risk for early readmission and identifies at-risk asthmatic children who may benefit from targeted interventions at hospital discharge.
- Copyright © 2007 by the American Academy of Pediatrics