Mild asthma exacerbations linked to unnecessary hospitalizations
BALTIMORE — Recent data presented at the Pediatric Academic Societies Meeting indicated that a significant percentage of unnecessary hospitalizations were associated with mildly acute asthma exacerbations.
“Asthma exacerbation remains the most frequent reason for hospitalization in children,” Colin G. Walsh, MD, MA, assistant professor of biomedical informatics, medicine, and psychiatry at Vanderbilt University Medical Center, told Infectious Diseases in Children. “We sought to determine the proportion of mild, moderate, and severe asthma exacerbations according to a validated asthma intensity score — the Acute Asthma Intensity Research Score (AAIRS).”
Colin G. Walsh
AAIRS, created and implemented by study researcher Donald H. Arnold, MD, FAAP, MPH, associate professor of emergency medicine and pediatrics of Vanderbilt University School of Medicine, categorizes exacerbation severity levels as mild, moderate and severe.
“We used natural language processing tools developed in our lab to extract the AAIRS score from electronic health record data,” Walsh said. He and his colleagues analyzed records from 575 patients (median age, 5 years; 67.5% male; 45.5% African American) hospitalized for asthma at an urban children’s hospital ED from May 1, 2014 to July 1, 2015.
The researchers used the chi-square test to assess the rates of unnecessary asthma hospitalizations (UAH). A multivariable logistic regression model that adjusted for age, gender and race was implemented to analyze the associations of UAH.
“Our analysis showed that the majority of admissions for asthma exacerbations in children — 88% of 575 admissions in 1 year — met criteria for mild exacerbations,” Walsh said. “Moreover, we determined that a large proportion of those mild severity admissions were discharged within 24 hours, which does not meet one of the major published criteria for necessity of hospitalization (the other being that patients did not return to acute care within 48 hours if they are discharged home).”
Overall, hospitalized patients had an average mild AAIRS. Necessary and UAH distributions were similar. Ninety-five percent of UAHs had mild severity, while 40.7% of those were hospitalized unnecessarily, compared with 15.6% of those with moderate or severe exacerbations.
After adjustment for age, gender and race, patients with mild severity were found to be more likely to endure unnecessary hospitalization.
“A growing body of research suggests that unnecessary admissions pose a financial, social, and health burden on families,” Walsh said. “Our future research will use our validated model predicting need for hospitalization in asthma exacerbations to help clinicians stratify risk in the high-stakes, data-intensive environment of the pediatric ED.
“It’s critical to note that the decision to admit patients is complex and that children who are discharged home should have ready access to contact care providers to ensure a safe, optimal care plan.” – by Alaina Tedesco
Walsh CG, et al. Abstract 1650.5. Presented at: Pediatric Academic Societies Meeting; April 30-May 3, 2016; Baltimore.
Vanderbilt University School of Medicine. Harbor Lab. Applying Data Science to Enable Population Health. https://medschool.vanderbilt.edu/harbor-lab. Accessed April 30, 2016.
Disclosure: The researchers report no relevant financial disclosures.