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Patient Characteristics Associated with Prolonged Hospital Stay for Status Asthmaticus

Abstract 55 Poster Session III, Monday, 5/3 (poster 173)

Objective: To identify patient demographic characteristics and clinical factors that are associated with increased length of stay (LOS) among hospitalized asthmatic children.

Background: Hospitalization for pediatric asthma has increased substantially since the late 1970s, particularly in children less than 5 years of age. Despite advances in the understanding of the disease as well as improvements in treatment, asthma remains the most common reason for admission at the vast majority of children's hospitals. Previous studies suggest that emergency room care and hospitalization account for as much as 50% of the total cost of asthma care. While many hospitals and payors have focused on reducing hospital LOS for children hospitalized with status asthmaticus in efforts to reduce costs, the factors contributing to LOS for asthma have not been established.

Study Population: We examined hospitalizations of children greater than 2 years of age [mean 5.48 ± 3.8 years] at Lucile Salter Packard Children's Hospital at Stanford from 6/1/96-5/31/97 with a primary diagnosis of asthma (n=65 hospitalizations for 60 patients). Children who required repeat hospitalization were counted once. The study excluded children who were admitted to the ICU or who had a complicating medical diagnosis.

Methods: We performed a retrospective review of medical records over a one year period. Two sided T test and chi square test were used to compare patients who required <4 days hospitalization and those who required ≥ 4 days hospitalization.

Results: The mean LOS for all hospitalized asthma children was 2.63 ± 1.8 days (range 1-10 days). Overall 82% of patients had prior known wheezing or asthma diagnosis; however, only 29% used anti-inflammatory medications prior to the hospitalization. Fourteen children (23.3%) required a hospital stay of ≥ 4 days (mean LOS 5.14 days). Compared to patients who had LOS < 4 days, those with hospital stays ≥ 4 days were more likely to be African-American (42.9% vs. 15.2%, p=.028), were older (8.5 years vs. 4.6 years, p=.0004), and had greater number of prior hospitalizations for asthma (p=.01). Children with LOS ≥ 4 days had hospitalization costs nearly four times greater than those hospitalized for < 4 days (p=.001). No differences in LOS were observed in sex distribution, insurance status, prior known wheezing/asthma diagnosis, or prior asthma medication use between the two groups.

Conclusion: Low use of anti-inflammatory medications prior to hospitalization suggests that patients hospitalized for asthma were undertreated in outpatient settings. Patients requiring prolonged LOS for asthma were more likely to be African-American, were older, and had increased prior asthma hospitalizations. Because these longer hospitalizations resulted in considerably higher inpatient costs, creation of guidelines that effectively reduce asthma care costs requires the identification of risk factors associated with prolonged LOS for asthma.

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(Spon by: Ann Arvin)

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Mayer, M., Hoyte, E. & Shames, R. Patient Characteristics Associated with Prolonged Hospital Stay for Status Asthmaticus. Pediatr Res 45, 11 (1999).

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