Risk Factors for Pediatric Asthma Readmissions: A Systematic Review

Hogan, Alexander H.; Carroll, Christopher L.; Iverson, Marissa G.; Hollenbach, Jessica P.; Philips, Kaitlyn; Saar, Katarzyna; Simoneau, Tregony; Sturm, James T.; Vangala, Divya; Flores, Glenn

doi:10.1016/j.jpeds.2021.05.015

Cited by 11 publications

(11 citation statements)

References 95 publications

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“…This strategy reduces the symptoms’ frequency, impact on lifestyle, and recurrence. Good knowledge helps patients prevent a recurrence of asthma attacks [ 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Determining the relationship between the knowledge on self-management and levels of asthma control among adult asthmatic patients: a cross-sectional study

Ghozali,

Urrohmah

2023

JMedLife

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The primary aim of asthma management is to improve the patient's quality of life and keep the symptoms under control, therefore improving the patient's daily activities. Asthmatic patients who know and understand how to control their symptoms could be able to prevent further attacks. Many previous studies have shown the role of patient knowledge regarding asthma self-management in improving asthma control. It was why this study mainly aimed to determine the relationship between patient knowledge of self-management and asthma control levels among adult asthmatic patients in the rural community. The design used analytical observation with a cross-sectional approach to collect data. It involved 100 asthmatic outpatients from two private hospitals owned by the Muhammadiyah Society in the Special Region of Yogyakarta, Indonesia, from February to August 2022. Most participants had a low level of knowledge (66%;n=66), followed by a good level of knowledge (34%;n=34). Regarding the levels of asthma control, it could be confirmed that 61% (n=61) of study participants had uncontrolled asthma, followed by partially controlled (35%;n=35), and controlled (4%;n=4). In terms of the relationship between two variables (patient knowledge of self-management and asthma control levels), the results of Pearson Chi-Square showed a p-value of 0.001, highlighting a relationship between the patient's knowledge of self-management and levels of asthma control. This study concluded that there was a strong relationship between knowledge regarding asthma self-management and asthma control levels.

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“…This strategy reduces the symptoms’ frequency, impact on lifestyle, and recurrence. Good knowledge helps patients prevent a recurrence of asthma attacks [ 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Determining the relationship between the knowledge on self-management and levels of asthma control among adult asthmatic patients: a cross-sectional study

Ghozali,

Urrohmah

2023

JMedLife

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“…In addition, we performed sensitivity analyses using an exponential distribution and with the outcome of readmission at 30 and 60 days to address concerns of the potential time-varying nature of readmission at 1 year. Asthma diagnosis was a component of the algorithmic ARDS definition, yet asthma readmission risk factors have been extensively studied . We performed a subanalysis excluding 288 children with asthma to examine whether ARDS readmission associations were altered by the presence of asthma.…”

Section: Methodsmentioning

confidence: 99%

Readmission Rates After Acute Respiratory Distress Syndrome in Children

Keim,

Hsu,

Pinto

et al. 2023

JAMA Netw Open

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ImportanceAn increasing number of children survive after acute respiratory distress syndrome (ARDS). The long-term morbidity affecting these survivors, including the burden of hospital readmission and key factors associated with readmission, is unknown.ObjectiveTo determine 1-year readmission rates among survivors of pediatric ARDS and to investigate the associations of 3 key index hospitalization factors (presence or development of a complex chronic condition, receipt of a tracheostomy, and hospital length of stay [LOS]) with readmission.Design, Setting, and ParticipantsThis retrospective cohort study used data from the commercial or Medicaid IBM MarketScan databases between 2013 and 2017, with follow-up data through 2018. Participants included hospitalized children (aged ≥28 days to &lt;18 years) who received mechanical ventilation and had algorithm-identified ARDS. Data analysis was completed from March 2022 to March 2023.ExposuresComplex chronic conditions (none, nonrespiratory, and respiratory), receipt of tracheostomy, and index hospital LOS.Main Outcomes and MeasuresThe primary outcome was 1-year, all-cause hospital readmission. Univariable and multivariable Cox proportional hazard models were created to test the association of key hospitalization factors with readmission.ResultsOne-year readmission occurred in 3748 of 13 505 children (median [IQR] age, 4 [0-14] years; 7869 boys [58.3%]) with mechanically ventilated ARDS who survived to hospital discharge. In survival analysis, the probability of 1-year readmission was 30.0% (95% CI, 29.0%-30.8%). One-half of readmissions occurred within 61 days of discharge (95% CI, 56-67 days). Both respiratory (adjusted hazard ratio [aHR], 2.69; 95% CI, 2.42-2.98) and nonrespiratory (aHR, 1.86; 95% CI, 1.71-2.03) complex chronic conditions were associated with 1-year readmission. Placement of a new tracheostomy (aHR, 1.98; 95% CI, 1.69-2.33) and LOS 14 days or longer (aHR, 1.87; 95% CI, 1.62-2.16) were associated with readmission. After exclusion of children with chronic conditions, LOS 14 days or longer continued to be associated with readmission (aHR, 1.92; 95% CI, 1.49-2.47).Conclusions and RelevanceIn this retrospective cohort study of children with ARDS who survived to discharge, important factors associated with readmission included the presence or development of chronic medical conditions during the index admission, tracheostomy placement during index admission, and index hospitalization of 14 days or longer. Future studies should evaluate whether postdischarge interventions (eg, telephonic contact, follow-up clinics, and home health care) may help reduce the readmission burden.

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“…Hospital admission has consistently been found to be one of the strongest predictors for subsequent admissions, and thus identifying and mitigating risk factors in this group of asthmatic children is important. 4,5 Sleep disordered breathing (SDB), which includes obstructive sleep apnea (OSA), is one condition that may complicate asthma. The relationship between OSA and asthma is bidirectional and complex.…”

Section: Introductionmentioning

confidence: 99%

Screening for sleep disordered breathing among children hospitalized for asthma exacerbation

Gurbani,

Schuler,

Ignatiuk

et al. 2023

Pediatric Pulmonology

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BackgroundSleep disordered breathing (SDB) may exacerbate asthma and is a treatable comorbidity.ObjectiveTo design and implement a screening process for SDB in patients hospitalized for asthma exacerbation using quality improvement (QI) methods. We sought to improve screening for SDB from zero to 60% from July 2019 to December 2020.Design/MethodsA multidisciplinary team used QI methods to screen for SDB using the Michigan pediatric sleep questionnaire (PSQ) in patients 2−18 years hospitalized for asthma exacerbation. Key interventions included: pairing the PSQ screen with another element of routine care (the asthma risk factor screen), educating staff and physicians, engaging respiratory therapists to complete the PSQ and document scores, and modifying the electronic medical record (asthma order set and flowsheet for PSQ score documentation). A run chart tracked progress and descriptive statistics were generated.ResultsThere were 2067 patients admitted for asthma exacerbation during this project. The PSQ was completed for 1531 patients (74%) overall. Of screened patients, 360 (24%) had a positive PSQ; the mean age was 8.6 years. Approximately 14 months after the project began, ~90% of children admitted for asthma were being screened; subsequently, >80% of patients were being screened until May 2022. Screening with the PSQ occurred approximately 90% of the time when routine asthma risk screens were completed.ConclusionA screening process for SDB was successfully implemented and appeared feasible and sustainable. The high proportion of positive screens reinforces the importance of evaluating for SDB in the high‐risk population of children requiring hospitalization for asthma exacerbation.

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Risk Factors for Pediatric Asthma Readmissions: A Systematic Review

Cited by 11 publications

References 95 publications

Determining the relationship between the knowledge on self-management and levels of asthma control among adult asthmatic patients: a cross-sectional study

Determining the relationship between the knowledge on self-management and levels of asthma control among adult asthmatic patients: a cross-sectional study

Readmission Rates After Acute Respiratory Distress Syndrome in Children

Screening for sleep disordered breathing among children hospitalized for asthma exacerbation

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