Comparison of Treatment Modalities for Inpatient Asthma Exacerbation Among U.S. Pediatric Hospitals
Monday, March 7, 2016
South Exhibit Hall H (Convention Center)
Meredith A. Dilley, MD, William J. Sheehan, MD, Dionne Graham, PhD, Carter Petty, MA, Wanda Phipatanakul, MD MS FAAAAI

Rationale: Asthma is the leading cause of hospitalization in the pediatric population and impacts quality of life. Identifying the most effective therapies for severe asthma exacerbations requiring hospitalization based on length of stay (LOS) and Pediatric Intensive Care Unit (PICU) admission outcomes is not well established.

Methods:  We utilized the Pediatric Health Information System (PHIS) database, a national billing code database of 43 free-standing pediatric hospitals, to identify children ages 6-17 hospitalized for asthma from 2010-2014 to determine differences in use of asthma therapies in relation to LOS and PICU admission. All results were adjusted for illness severity based on diagnosis-related severity code.

Results:  59,114 hospital admissions for asthma were evaluated.  60.8% were male with 31.0% White, 53.3% Black, 1.4% Asian, 0.2% Pacific Islander, 0.5% American Indian, and 11.4% Other races. Hispanic ethnicity comprised 16.9% of the population. Whites had 3% shorter LOS (p=0.04) and 18% fewer PICU admissions (p=0.006). American Indians and Other races had 54% (p=0.002) and 25% (p<0.001) fewer PICU admissions, respectively. Terbutaline was associated with 48% longer LOS (p<0.001) and higher risk of PICU admission (OR=4.32, p<0.001). Magnesium sulfate was associated with 29% longer LOS (p<0.001) and higher risk of PICU admission (OR=6.93, p<0.001). Heliox was associated with 24% longer LOS (p<0.001) and higher risk of PICU admission (OR=4.30, p<0.001).

Conclusions: Treatment with terbutaline, magnesium and heliox were each separately associated with longer LOS and risk of PICU admission, independent of severity of the admission. Future analysis will determine treatment-related outcomes based on regional treatment variations in the U.S.