341 - Predicting Disposition in Asthma Exacerbations Through A Standardized Scoring System

Poster Number: 341
Publication Number: 341.204

Alex Kingsbury, University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States; Elisha McCoy, Le Bonheur Children's Hospital, Memphis, TN, United States; Mark Meredith, Le Bonheur Children's Hospital, Burlison, TN, United States

Background: As asthma continues to represent a significant financial burden to the United States healthcare system, hospitals have utilized clinical algorithms to improve length of stay, patient disposition, and clinical outcomes for acute exacerbations. Using a standard respiratory clinical score (RCS) to progress a patient through an asthma algorithm, emergency departments (ED) have demonstrated shorter lengths of stay and improved patient dispositions. This tool has facilitated rapid assessment and treatment by providers.

Objective: The primary outcome of this study was to determine whether initial RCS at presentation was predictive of hospitalization. Secondary outcomes include time to steroids as a predictor of patient disposition and hypoxemia (SpO2 < 90%) on presentation as a predictor of pediatric intensive care unit admission (PICU).

Design/Methods: This study was a retrospective chart review of patients presenting to a tertiary children’s hospital emergency department from 03/2016 to 01/2019 with the primary complaint of wheeze or asthma exacerbation in a known asthmatic patient. Patients aged 2-18 were included for analysis. Patients with a discharge diagnosis of bronchiolitis or a co-morbid history of respiratory tract anomalies or chronic respiratory disease not classified as asthma were excluded. Key points of interest included patient demographics, RCS at presentation, time to steroids from triage, triage SpO2, and patient disposition.

Results: A total of 17,596 subjects were evaluated. The mean age of subjects was 8.12 years, 78% of subjects were African American, and 58% were male. Seventy-four percent of patients were discharged from the ED and 26% were admitted. Triage RCS was available in 9,934 encounters. For every unit increase in the RCS at arrival, the odds of hospitalization increased by 28% (odds ratio (OR) 1.281, p-value < 0.001). In patients presenting with hypoxemia (n=239 of 14267 encounters), the OR of PICU admission was 14.51 (p < 0.001). Patients who received steroid administration (observations n = 10,513) within sixty minutes of triage had improved disposition (home vs. admission, PICU admission) with an odds ratio of 1.27 (95% CI 1.125 – 1.436).Conclusion(s): This study is a large, single-center study that evaluated the ability of an initial RCS to predict hospital admission, demonstrating increased risk of hospitalization per unit increase of score. Patients who presented with hypoxemia were more likely to require PICU admission, while patients who received steroids within sixty minutes of presentation were more likely to be discharged home.