Chest
Clinical InvestigationsAsthma Exacerbations in North American Adults: Who Are the “Frequent Fliers” in the Emergency Department?
Section snippets
Materials and Methods
The present analysis combined data from four prospective cohort studies performed during 1996 to 2001, as part of the Multicenter Airway Research Collaboration (MARC). MARC is part of the Emergency Medicine Network (EMNet), a collaboration with > 160 participating EDs.11 Using a standardized protocol, investigators at 83 EDs in 26 US states enrolled patients 24 h/d for a median of 2 weeks. The Institutional Review Board at each of the 83 participating hospitals approved the study, and informed
Results
Of 3,257 asthmatic patients enrolled, 3,151 patients (97%) had data on NEDV and were included in the current analysis. Eight hundred sixty-three patients (27%) reported no prior ED visits, while 843 patients (27%) had one to two visits, 791 patients (25%) had three to five visits, and 654 patients (21%) had six or more visits in the past year. Figure 1 depicts the cumulative number of ED visits during the prior year in each of these four frequency groups. Patients with one to two visits (n =
Discussion
To our knowledge, this is the first large, multicenter study that characterizes asthma patients who frequently utilize the ED for their asthma care. The data were drawn from > 3,000 patients in 83 US EDs. Based on the diversity of these sites, and similar results from previous smaller-scale studies,1415 we believe that our findings can be generalized to other EDs and may help to identify and target adult asthma patients with very frequent use of the ED for their asthma care.
To date, most
Summary
Patients with high NEDV were more likely to be nonwhite, of lower socioeconomic status, have Medicaid insurance, and have higher chronic asthma severity. Patients with six or more ED visits accounted for 20% of consecutive ED patients with acute asthma, and 68% of all prior ED visits in the past year. National guidelines recommend specific ED treatments followed by referral to PCP, with unclear recommendations about if and when to refer patients to asthma specialists. We found no relation
Appendix EMNet Steering Committee
Edwin D. Boudreaux, PhD; Barry E. Brenner, MD, PhD; Carlos A. Camargo, Jr., MD (Chair); Rita K. Cydulka, MD; Theodore J. Gaeta, DO, MPH; and Michael S. Radeos, MD, MPH.
EMNet Coordinating Center
Carlos A. Camargo, Jr., MD (Director); Sunday Clark, MPH; Lisa A. Dubois; Sunghye Kim, MD, MSc; Sarah N. Kunz; Andrea J. Pelletier, MS, MPH; Elizabeth Portnoy; Ilana B. Richman; Ashley F. Sullivan, MS, MPH; all at Massachusetts General Hospital, Boston, MA.
Principal Investigators at the 83 Participating Sites
G. Almond (Metropolitan Hospital Center, New York, NY); G. Almond and D. Feingold (Our Lady of Mercy Medical Center, Bronx, NY); F.C. Baker III (Maine Medical Center, Portland, ME); J.M. Baren (Children's Hospital of Philadelphia, Philadelphia, PA); J.M. Baren, S. Stahmer (Hospital of the University of Pennsylvania, Philadelphia, PA); J.M. Basior (Buffalo General Hospital, Buffalo, NY); B. Bauman (Oregon Health Sciences University Hospital, Portland, OR); R.S. Benenson (York Hospital, York,
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2019, American Journal of Emergency MedicineCitation Excerpt :Interestingly, a number of the findings from our multivariate analysis deviate from previous literature. First, this study does not re-demonstrate a clinically meaningful increase in likelihood of frequent use among African American or Hispanic patients when compared to White patients, as described in previous pediatric and adult research [1-3,18,26,27]. In fact, the most notable difference in terms of race is that children with Asian racial/ethnic backgrounds are roughly half as likely to be frequent users as their White counterparts.
Risk Factors for Return to the Emergency Department for Asthma: A Population-Based Study
2018, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :Finally, the relationship between sex and ED return is less clear. Some studies found that males were more likely to have repeat ED visits,19 but others did not find any significant relationship with sex.5,7,17,18 However, previous studies are limited by their use of small clinical samples and single center studies.4,7,8,10,12,13,16-18,20,21
Ms. Clark is supported by grant T32 ES07069 and Dr. Camargo is supported by grant HL63841 from the National Institutes of Health. The cohort studies were supported by unrestricted grants from GlaxoSmithKline (Research Triangle Park, NC).
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestjournal.org/misc/reprints.shtml).