Jonathon Gutzeit, MD, MPH
Chief Resident, Instructor
n/a
Milwaukee, Wisconsin
Disclosure information not submitted.
Juan Ruiz, MD
Assistant Professor of Pediatrics
Children's Wisconsin - Department of Pulmonology, United States
Disclosure information not submitted.
Amy Pan, PhD
Assistant Professor
Medical College of Wisconsin - Division of Quantitative Health Sciences, United States
Disclosure information not submitted.
Theresa Mikhailov, MD, PhD
Professor of Pediatrics (Critical Care)
Childrens Hospital of Wisconsin, United States
Disclosure information not submitted.
Pippa Simpson, PhD
Professor, Director
Medical College of Wisconsin - Division of Quantitative Health Sciences, United States
Disclosure information not submitted.
Title: Pediatric Intensive Care Length of Stay for Asthma: Does Institution of Origin Contribute?
Introduction:
Asthma is a leading cause of chronic disease in children and it is not uncommon that children admitted with status asthmaticus require pediatric intensive care unit (PICU) level of care. The goal of this study was to determine if emergency department (ER) of origin (internal versus external) has an impact on PICU length of stay (LOS).
Methods:
We performed a retrospective cohort study with de-identified patient data obtained from the Virtual Pediatric Systems (VPS, LLC) data registry. The population of interest was children with a primary diagnosis of status asthmaticus admitted to a PICU between January 2015 and March 2020. Primary exposure was ER of origin, either an ER with a PICU in the same institution (internal) or an ER from an institution not associated with a PICU (external). We excluded subsequent admissions for the same patient during the study period. We compared categorical variables by Chi-square test and continuous variables by Mann-Whitney-Wilcoxon test. We used a general linear model to adjust for confounding variables [age, gender, race/ethnicity, PIM3 risk of mortality (PIM3ROM), and weight for age]. P< 0.05 was considered statistically significant.
Results:
Of 34595 cases over the specified time interval, 28644 were first admission to the PICU for status asthmaticus who met other inclusion criteria for the specified dates. Children admitted from an external ER were older [median 84 months, (IQR 52-131) vs. 79 months, (IQR 50-122), p < 0.0001) and less likely to be African American (26.56% versus 40.9%, p < 0.0001) than children admitted from an internal ER. They did not differ in gender, weight for age, or PIM3ROM. Median LOS for admission from an external ER was longer than from an internal ER [1.21 days (IQR 0.69-2.07) vs. 1.04 days (IQR 0.62-1.77), p < 0.0001]. This difference remains statistically significant after controlling for age, gender, race/ethnicity, weight for age percentile, and PIM3ROM, p< 0.0001.
Conclusions:
Compared to children admitted to the PICU from an internal ER those from an external ER had an overall longer PICU medical LOS. This finding holds true regardless of gender, age, race/ethnicity, weight for age percentile, and PIM3ROM. This may suggest the need for improved adherence to standardized asthma treatment guidelines.