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.
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.
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.
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.(Arch Pediatr Adolesc Med. 1995;149:276-279)