Original ArticleRegional Variation in ICU Care for Pediatric Patients with Asthma
Section snippets
Data Source
This study utilized data from a large, multi-institutional administrative database, the Pediatric Health Information System (PHIS). The PHIS database is maintained by the pediatric hospital members of the Child Health Corporation of America (CHCA), which currently includes 41 member hospitals.8 CHCA is a business alliance of pediatric hospitals that provides a range of products and services designed to reduce cost, increase revenue, and enhance the competitiveness of children's hospitals. The
Results
Of 87,875 pediatric patients treated for asthma in a participating hospital during the study period, 7125 (8%) received care in a PICU. Selected demographic features of the PICU patients are shown in Table I. One thousand twenty-four children (14%) received invasive ventilation. Use of mechanical ventilation differed by area of the country, as did severity of illness assessed by APR-DRG (highest severity score). Use of mechanical ventilation varied from 6% in the Pacific census division
Discussion
Our study found large variability in use of asthma therapies for pediatric patients with severe exacerbations. Variability was noted in the administration of recommended medications such as inhaled anticholinergics as well as medications with less convincing evidence to support their use for severe exacerbations (eg, methylxanthines and systemic β-agonists). There was marked regional variation in the use of inhaled heliox, noninvasive mechanical ventilation, and invasive mechanical ventilation
References (39)
- et al.
Heliox vs air-oxygen mixtures for the treatment of patients with acute asthma: a systematic overview
Chest
(2003) - et al.
Physician asthma education program improves outcomes for children of low income families
Chest
(2004) - et al.
Asthma severity and adequacy of management in accident and emergency departments in France: a prospective study
Lancet
(2001) - et al.
Administration of therapeutic aerosols to mechanically ventilated patients
Chest
(1994) - et al.
The effectiveness of IV β-agonists in treating patients with acute asthma in the emergency department: a meta-analysis
Chest
(2002) - et al.
Noninvasive positive pressure ventilation in status asthmaticus
Chest
(1996) - et al.
Trials comparing alternative weaning modes and discontinuation assessment
Chest
(2001) - et al.
The Pediatric Risk of Mortality III-Acute Physiology Score (PRISM III–APS): a method of assessing physiologic instability for pediatric intensive care unit patients
J Pediatr
(1997) - et al.
Annual Report on Access to and Utilization of Health Care for Children and Youth in the United States: 1999
Pediatrics
(2000) - et al.
Acute severe asthma: differences in therapies and outcomes among pediatric intensive care units
Crit Care Med
(2002)
An economic evaluation of asthma in the United States
N Engl J Med
Health care utilization and cost among children with asthma who were enrolled in a health maintenance organization
Pediatrics
Practical guide for the diagnosis and management of asthma. [Based on the Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma]
Improving childhood asthma outcomes in the United States: a blueprint for policy action
Pediatrics
St Anthony's Softbound ICD-9 Code Book, 1997
Cited by (76)
A description of children dependent on long term ventilation via tracheostomy and their hospital resource use
2021, Journal of Pediatric NursingComparison of treatment modalities for inpatient asthma exacerbations among US pediatric hospitals
2017, Journal of Allergy and Clinical Immunology: In PracticeTreatment, outcomes and costs of asthma exacerbations in Chilean children: a prospective multicenter observational study
2019, Allergologia et ImmunopathologiaCitation Excerpt :Due to lack of scientific evidence on the use of antibiotics for asthma exacerbations, GINA guidelines recommend reserving its indication only for patients with clear symptoms of a lung infection, such as fever, purulent sputum and chest X-rays consistent with bronchopneumonia.10 Some 17.4% of patients required treatment in the PICU, an intermediate value between the 8% reported by an American study and the 20.3% reported in a Saudi study.11,12 The higher percentage found in this series in comparison with the American one could be due to a greater severity of exacerbations in our patients or to a lower threshold for PICU admittance and care.
Wide Institutional Variability in the Treatment of Pediatric Critical Asthma: A Multicenter Retrospective Study
2024, Pediatric Critical Care MedicineHeliox as Adjunctive Therapy for Pediatric Critical Asthma: Time to Question Its Role?
2022, Respiratory CareReducing Avoidable Transfer Delays in the Pediatric Intensive Care Unit for Status Asthmaticus Patients
2022, Pediatric Quality and Safety