Tags

Type your tag names separated by a space and hit enter

Risk factors for an intensive care unit admission in children with asthma.
Pediatr Pulmonol 2004; 37(3):201-9PP

Abstract

An admission to an intensive care unit (ICU) with asthma is a marker of asthma severity and may be a precursor of asthma death. The aim of this study was to investigate risk factors for acute severe asthma needing an ICU admission. We hypothesized that children admitted to the ICU represent a severe phenotype with identifiable premorbid clinical features. The study was case-control in design. One hundred and forty-one children were studied. Seventy children admitted to the ICU and 71 children admitted to the general medical ward served as cases and controls, respectively. Children were aged between 1-16 years. They underwent skin prick allergy testing, and had a nasopharyngeal aspirate and serology performed to screen for respiratory pathogens. Their parents completed an asthma and allergy symptom questionnaire and the Newcastle Asthma Knowledge Questionnaire (NAKQ). On univariate analysis, an admission to the ICU was more likely in children with 1) "frequent episodic" or "persistent" background asthma; 2) three or more previous admissions for asthma; 3) one or more asthma admissions in the previous 12 months; 4) three or more presentations to the Emergency Department (ED) in the preceding 12 months; 5) three or more positive responses on skin prick allergy testing; 6) an elevated IgE level; 7) oxygen saturation on presentation < or =91%; 8) longer duration of asthma; 9) lower level of maternal education; 10) an admission during autumn; 11) three or more siblings; and 12) being prescribed antibiotics. Risk factors that remained significant on multivariate analysis were three or more presentations to the ED in the preceding 12 months (P=0.003), an elevated IgE level (P=0.01), oxygen saturation on presentation < or =91% (P=0.003), and longer asthma duration (P=0.02). ICU patients took longer to see a doctor and to commence oral steroids. No differences were found between cases and controls in the proportion taking preventer therapy (58% vs. 52%), provided with a written asthma action plan (32% vs. 25%), or in whom spirometry or peak flow was measured (28% vs. 42%). However, rates were low in both groups. Parental asthma knowledge was generally poor. This study identified risk factors for an ICU admission in children with asthma. A potentially preventable risk factor is a history of multiple ED presentations in the past year. Specialist referral of children with multiple ED presentations may improve asthma control and reduce the risk of an ICU admission. Background asthma management remains suboptimal in children needing hospitalization.

Authors+Show Affiliations

Department of Respiratory Medicine, Sydney Children's Hospital, Randwick, New South Wales, Australia. y.belessis@unsw.edu.auNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

14966813

Citation

Belessis, Yvonne, et al. "Risk Factors for an Intensive Care Unit Admission in Children With Asthma." Pediatric Pulmonology, vol. 37, no. 3, 2004, pp. 201-9.
Belessis Y, Dixon S, Thomsen A, et al. Risk factors for an intensive care unit admission in children with asthma. Pediatr Pulmonol. 2004;37(3):201-9.
Belessis, Y., Dixon, S., Thomsen, A., Duffy, B., Rawlinson, W., Henry, R., & Morton, J. (2004). Risk factors for an intensive care unit admission in children with asthma. Pediatric Pulmonology, 37(3), pp. 201-9.
Belessis Y, et al. Risk Factors for an Intensive Care Unit Admission in Children With Asthma. Pediatr Pulmonol. 2004;37(3):201-9. PubMed PMID: 14966813.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk factors for an intensive care unit admission in children with asthma. AU - Belessis,Yvonne, AU - Dixon,Susan, AU - Thomsen,Amanda, AU - Duffy,Barry, AU - Rawlinson,William, AU - Henry,Richard, AU - Morton,John, PY - 2004/2/18/pubmed PY - 2004/6/2/medline PY - 2004/2/18/entrez SP - 201 EP - 9 JF - Pediatric pulmonology JO - Pediatr. Pulmonol. VL - 37 IS - 3 N2 - An admission to an intensive care unit (ICU) with asthma is a marker of asthma severity and may be a precursor of asthma death. The aim of this study was to investigate risk factors for acute severe asthma needing an ICU admission. We hypothesized that children admitted to the ICU represent a severe phenotype with identifiable premorbid clinical features. The study was case-control in design. One hundred and forty-one children were studied. Seventy children admitted to the ICU and 71 children admitted to the general medical ward served as cases and controls, respectively. Children were aged between 1-16 years. They underwent skin prick allergy testing, and had a nasopharyngeal aspirate and serology performed to screen for respiratory pathogens. Their parents completed an asthma and allergy symptom questionnaire and the Newcastle Asthma Knowledge Questionnaire (NAKQ). On univariate analysis, an admission to the ICU was more likely in children with 1) "frequent episodic" or "persistent" background asthma; 2) three or more previous admissions for asthma; 3) one or more asthma admissions in the previous 12 months; 4) three or more presentations to the Emergency Department (ED) in the preceding 12 months; 5) three or more positive responses on skin prick allergy testing; 6) an elevated IgE level; 7) oxygen saturation on presentation < or =91%; 8) longer duration of asthma; 9) lower level of maternal education; 10) an admission during autumn; 11) three or more siblings; and 12) being prescribed antibiotics. Risk factors that remained significant on multivariate analysis were three or more presentations to the ED in the preceding 12 months (P=0.003), an elevated IgE level (P=0.01), oxygen saturation on presentation < or =91% (P=0.003), and longer asthma duration (P=0.02). ICU patients took longer to see a doctor and to commence oral steroids. No differences were found between cases and controls in the proportion taking preventer therapy (58% vs. 52%), provided with a written asthma action plan (32% vs. 25%), or in whom spirometry or peak flow was measured (28% vs. 42%). However, rates were low in both groups. Parental asthma knowledge was generally poor. This study identified risk factors for an ICU admission in children with asthma. A potentially preventable risk factor is a history of multiple ED presentations in the past year. Specialist referral of children with multiple ED presentations may improve asthma control and reduce the risk of an ICU admission. Background asthma management remains suboptimal in children needing hospitalization. SN - 8755-6863 UR - https://www.unboundmedicine.com/medline/citation/14966813/Risk_factors_for_an_intensive_care_unit_admission_in_children_with_asthma_ L2 - https://doi.org/10.1002/ppul.10443 DB - PRIME DP - Unbound Medicine ER -