31 - Trends in Pediatric Acute Severe Asthma Admissions Requiring ICU, 2010-2020

Poster Number: 31

Diane Peng, Children's Hospital Colorado, Denver, CO, United States; Angela S. Czaja, University of Colorado School of Medicine, Aurora, CO, United States

Background: Children hospitalized with acute severe asthma may require intensive care unit (ICU) admission with risk of morbidity and mortality. However, our understanding of recent therapeutic management and outcomes in this population is limited.

Objective: To describe trends in treatments and outcomes for pediatric asthma hospitalizations requiring ICU over the past decade.

Design/Methods: Retrospective cohort study using clinical and billing data from 34 U.S. children’s hospitals between 2010-2020. Only children 2-18 years with a primary diagnosis of asthma were included. Exclusion criteria were a secondary diagnosis of bronchiolitis or cystic fibrosis. ICU admission was identified through relevant charges. Demographics, asthma medications/treatment, and outcomes were obtained for the cohort. Changes over the study period were examined using nonparametric trend testing with p-value < 0.05 considered significant.

Results: 234,765 hospitalizations met inclusion/exclusion criteria, with 29,257 (12%) requiring ICU admission. Demographics and socioeconomic status were similar between children requiring ICU and those who did not (Table 1). However, ICU admissions were associated with a higher median length of hospital stay and total charges than non-ICU admissions. Among the ICU cohort, 67% received magnesium, 14% terbutaline, 6% methylxanthines, and 0.1% inhaled anesthetics. 22% received non-invasive positive pressure ventilation (NIPPV), 8% were mechanically ventilated, and 0.1% received extracorporeal membrane oxygenation (ECMO). Complications were rare with 0.5% developing air leak, 0.4% cardiac arrest, and 0.3% death. The median length of ICU stay was 1 day (IQR 1-2 days). Over the study period, the annual number of hospitalizations was variable, but the percentage requiring ICU admission remained stable (11-14%) (Figure 1). During ICU admission, both NIPPV and mechanical ventilation increased, but much greater for NIPPV (p < 0.001) (Figure 2). Terbutaline use decreased while methylxanthine use was variable but slightly increased (p < 0.001). Rates of ECMO (0.03%-0.35%), cardiac arrest (0.16%-0.66%), and death (0.11%-0.60%) remained stably low.Conclusion(s): Despite advances in outpatient therapies, pediatric hospitalizations for acute severe asthma have persisted with stable ICU rates. The approach to asthma treatment in the ICU has changed over time, especially non-invasive respiratory support. However, there is a low but persistent risk of death, suggesting ongoing need for improvement in this vulnerable population.
Table 1: Patient and admission characteristics for ICU and non-ICU hospitalizations
Figure 1: Asthma hospitalizations, 2010-2020Bars represent the number of total and ICU hospitalizations. The line represents the percent of hospitalizations requiring ICU admission.