WIP 02 - Delays in Asthma Treatment and Disposition Attributable to Undertriage in a Pediatric Emergency Department

Publication Number: WIP 02.7451

Maya McKeown, Children's National Health System, Washington, DC, United States; Nichole McCollum, Children's National Health System, Falls Church, VA, United States; Deena Berkowitz, Children's National Health System, Washington, DC, United States; James Chamberlain, Children's National Health System, Washington, DC, United States

Background: Asthma is one of the most common chronic diseases of childhood and a leading cause of emergency department (ED) visits and hospitalizations. Appropriate triage is essential to initiate timely interventions and prevent delays in care. Many EDs utilize the Emergency Severity Index (ESI) scoring system which stratifies patients into five groups according to illness severity and predicted resource needs. ESI 1 patients are the most emergent and ESI 5 patients are the least with 0 resource needs predicted. Undertriage, or the underestimation of acuity or resource needs, can cause delays in care and treatment potentially leading to adverse outcomes. There is a growing body of research about the impact of undertriage on pediatric patients, but little is known specifically about the clinical implications in pediatric asthma, a common and potentially life-threatening condition.

Objective: The objective of this study is to evaluate the clinical impact of undertriage on time to appropriate interventions and disposition in pediatric patients treated for asthma exacerbations in an urban emergency department.

Design/Methods: This is an IRB-approved, case-control study of ED visits for patients < 21 years old treated for asthma exacerbations. Cases (i.e. undertriage) had an assigned ESI score of 4 or 5, and need for hospital admission, nebulized treatment, oxygen, IV medication, or ventilatory support between July 2021 and 2024. Controls were sampled from patients treated for asthma with an ESI score of 3, matched by intervention, disposition, date and hour of arrival.
Data collection yielded 72 matched pairs. Continuous outcome variables (i.e. time to intervention) analyzed using paired t-tests initially show statistically significant differences in time to nebulizer treatment (p < 0.001). Dichotomous outcome variables (i.e. epinephrine given or not) will be analyzed with odds ratios. Data review and analyses are preliminary. This work will require 3 months for further analysis and review under mentorship. Future directions will evaluate risk factors for undertriage of asthma patients.