483 - Risk factors associated with escalation of care in hospitalized patients with asthma

Publication Number: 483.6322

Florinda Islamovic, The Children's Hospital at Montefiore, Bronx, NY, United States; Jonathan M. Gabbay, Albert Einstein College of Medicine, Bronx, NY, United States; Patricia Hametz, The Children's Hospital at Montefiore, Bronx, NY, United States; Marina Reznik, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY, United States

Background: Delay in ICU admission has been shown to be associated with adverse patient outcomes. Due to hospital variability, ICU admission alone may not capture patients who require escalation of therapy (EOT). However, there is limited literature describing risk factors including social drivers of health for children with asthma who require EOT, including ICU transfer. Identifying risk factors of those who are transferred to the ICU or require EOT, may provide insight into interventions to improve care.

Objective: To investigate risk factors of children hospitalized with asthma who require EOT.

Design/Methods: We conducted a retrospective cohort study, using the Pediatric Health Information System, of children 4-18 years old admitted to non-ICU settings for asthma exacerbations from January 1, 2018, to December 31, 2023 across 45 children’s hospitals. Our primary outcome was EOT, defined as transfer to the ICU, respiratory support or need for adjunctive therapy including epinephrine, terbutaline, aminophylline, theophylline, Heliox, magnesium sulfate or methylprednisolone after first day of admission. Mixed effects regression models were used to estimate the association between our primary outcome and exposures including age, sex, race, ethnicity, payor, child opportunity index (COI), complex chronic conditions (CCC) and season. Unique patient and hospital identifiers were used as random effects.

Results: A total of 91,121 encounters and 70,049 patients were included with 15,796 (17.34%) encounters requiring EOT (Table 1). In the adjusted model (Table 2), males compared to females and spring compared to summer admissions had lower odds of EOT (aOR=0.92 p< 0.001; aOR=0.93 [0.87, 0.98], respectively). Each additional year of age (aOR 1.04 [1.03, 1.04] p < 0.001) and having at least 1 CCC increased odds of EOT. No significant associations were found between EOT and COI, race or equity payor category.

Conclusion(s): In this large retrospective analysis, we identified key risk factors associated with EOT for children hospitalized with asthma exacerbation. Children who were older and female had increased odds of EOT. Interestingly, there were lower odds of EOT in spring admissions and no association between EOT and COI, equity payor category or race. There are limitations in using an administrative database, including lack of contextual information like severity of illness at admission. Further research is warranted to explore the mechanisms behind these associations and to develop strategies for effectively addressing disparities in patient care.

Demographic characteristics of pediatric patients admitted with status asthmaticus or acute exacerbation requiring escalation of therapy in 45 pediatrics hospitals
*reported as n (%) unless otherwise stated.

Table 2: Mixed effects logistic regression model of Escalation of Therapy in pediatric patients with asthma
1 Mixed effect logistic regression models adjusted for: age, sex, race, ethnicity, complex chronic conditions, payor category, APRDRG severity and season. Unique patient and hospital identifiers used as random effects.
2 Reference categories: COI ref= Very High, Sex= Female, Race= White, Ethnicity = Hispanic, Complex Chronic Conditions= No Complex Chronic Conditions, Equity Payor Categor= Non Governmental Insurance APR-DRG Severity= Minor, Season= Summer
3 Other race consists of Asian, Pacific Islander, American Indian and Other Specified race.