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Risk Factors for Repeat Adverse Asthma Events in Children After Visiting an Emergency Department
- Source :
- Ambulatory Pediatrics
- Publication Year :
- 2008
- Publisher :
- Elsevier BV, 2008.
-
Abstract
- Objective The aim of this study was to identify risk factors for long-term adverse outcomes in children with asthma after visiting the emergency department (ED). Methods A prospective observational study was conducted at the ED of a pediatric tertiary hospital in Ontario, Canada. Patient outcomes (ie, acute asthma episodes and ED visits) were measured at baseline and at 1- and 6-months post-ED discharge. Time trends in outcomes were assessed using the generalized estimating equations method. Multiple conditional logistic regressions were used to model outcomes at 6 months and examine the impact of drug insurance coverage while adjusting for confounders. Results Of the 269 children recruited, 81.8% completed both follow-ups. ED use significantly reduced from 39.4% at baseline to 26.8% at 6 months (P < .001), whereas the level of acute asthma episodes remained unchanged. Children with drug insurance coverage were less likely to have acute asthma episodes (adjusted odds ratio [AOR] = 0.36; 95% CI, 0.15–0.85; P < .02) or repeat ED visits (AOR = 0.45; 95% CI, 0.20–0.99; P < .05) at 6 months. Other risk factors for adverse outcomes included previous adverse asthma events and certain asthma triggers (eg, cold/sinus infection). Washing bed linens in hot water weekly was protective against subsequent acute asthma episodes. Conclusions Our study demonstrated significant improvements in long-term outcomes in children seeking acute care for asthma in the ED. Future efforts remain in targeting the sustainability of improved outcomes beyond 6 months. Risk factors identified can help target vulnerable populations for proper interventions, which may include efforts to maximize insurance coverage for asthma medications and strategies to improve asthma self-management through patient and provider education.
- Subjects :
- Male
Urban Population
Psychological intervention
Severity of Illness Index
Cohort Studies
emergency department visit
0302 clinical medicine
Recurrence
Risk Factors
Acute care
Odds Ratio
Medicine
Anti-Asthmatic Agents
Prospective Studies
030212 general & internal medicine
Child
Ontario
General Medicine
Hospitals, Pediatric
Insurance, Pharmaceutical Services
Respiratory Function Tests
3. Good health
Treatment Outcome
Child, Preschool
Female
Emergency Service, Hospital
Cohort study
drug insurance coverage
medicine.medical_specialty
Adolescent
Status Asthmaticus
Article
03 medical and health sciences
children
030225 pediatrics
Severity of illness
Confidence Intervals
Humans
Asthma
business.industry
Emergency department
Odds ratio
asthma
medicine.disease
Logistic Models
Socioeconomic Factors
Pediatrics, Perinatology and Child Health
Emergency medicine
Patient Compliance
Observational study
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 15301567
- Volume :
- 8
- Database :
- OpenAIRE
- Journal :
- Ambulatory Pediatrics
- Accession number :
- edsair.doi.dedup.....d7892ce1f6491d4f2d01208e0b703b2a