Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Feb 8, 2017; 6(1): 34-39
Published online Feb 8, 2017. doi: 10.5409/wjcp.v6.i1.34
Pediatric asthma severity score is associated with critical care interventions
Danielle K Maue, Nadia Krupp, Courtney M Rowan
Danielle K Maue, Courtney M Rowan, Department of Pediatric Critical Care, Indiana University School of Medicine, Indianapolis, IN 46202, United States
Nadia Krupp, Department of Pediatric Pulmonology, Indiana University School of Medicine, Indianapolis, IN 46202, United States
Author contributions: Maue DK designed the research study, collected the data, assisted with statistical analysis, and wrote the manuscript; Krupp N contributed to the design of the study and edited the manuscript; Rowan C contributed to the design of the research study, assisted with statistical analysis, and edited the manuscript.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board at the Indiana University School of Medicine.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data. It was performed retrospectively and all data was de-identified and entered into a secure data collection website.
Conflict-of-interest statement: None of the authors have a conflict of interest or financial relationship to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Danielle K Maue, MD, Pediatric Critical Care fellow, Department of Pediatric Critical Care, Indiana University School of Medicine, Phase 2, 4B Office 4925, Indianapolis, IN 46202, United States. dmaue@iu.edu
Telephone: +1-317-9441388 Fax: +1-317-9443442
Received: July 8, 2016
Peer-review started: July 14, 2016
First decision: September 12, 2016
Revised: October 14, 2016
Accepted: November 1, 2016
Article in press: November 2, 2016
Published online: February 8, 2017
Abstract
AIM

To determine if a standardized asthma severity scoring system (PASS) was associated with the time spent on continuous albuterol and length of stay in the pediatric intensive care unit (PICU).

METHODS

This is a single center, retrospective chart review study at a major children’s hospital in an urban location. To qualify for this study, participants must have been admitted to the PICU with a diagnosis of status asthmaticus. There were a total of 188 participants between the ages of two and nineteen, excluding patients receiving antibiotics for pneumonia. PASS was calculated upon PICU admission. Subjects were put into one of three categories based on PASS: ≤ 7 (mild), 8-11 (moderate), and ≥ 12 (severe). The groups were compared based on different variables, including length of continuous albuterol and PICU stay.

RESULTS

The age distribution across all groups was similar. The median length of continuous albuterol was longest in the severe group with a duration of 21.5 h (11.5-27.5), compared to 15 (7.75-23.75) and 10 (5-15) in the moderate and mild groups, respectively (P = 0.001). The length of stay was longest in the severe group, with a stay of 35.6 h (22-49) compared to 26.5 (17-30) and 17.6 (12-29) in the moderate and mild groups, respectively (P = 0.001).

CONCLUSION

A higher PASS is associated with a longer time on continuous albuterol, an increased likelihood to require noninvasive ventilation, and a longer stay in the ICU. This may help safely distribute asthmatics to lower and higher levels of care in the future.

Keywords: Asthma, Noninvasive ventilation, Critical care, Albuterol

Core tip: This is a single center retrospective study designed to determine whether or not the pediatric asthma severity score was associated with critical care interventions. It was found that patients with a higher (more severe) severity score were more likely to require continuous albuterol for longer (P = 0.001) and were more likely to have a longer length of pediatric intensive care unit stay compared to those with less severe scores (P = 0.001). It was also determined that patients with a higher severity score were more likely to require other critical care interventions, including noninvasive positive pressure ventilation and amiodarone. This may help safely distribute asthmatics to higher and lower levels of care in the future.