The Science Journal of the American Association for Respiratory Care

1998 OPEN FORUM Abstracts

OUTCOMES FOR HOSPITALIZED ASTHMATICS BASED ON RSV STATUS

Timothy R. Myers, RRT, Carolyn Kercsmar MD and Robert Chatburn RRT. Case Western Reserve University and Rainbow Babies & Childrens Hospital, Cleveland, OH.

Aim: To determine if clinical outcomes for children hospitalized with status asthmaticus were affected by their respiratory syncytial viral (RSV) status. History: Children admitted to our asthma unit (ACU) for status asthmaticus since Sept. 1996 have been treated with an asthma care path (ACP). The ACP developed at our hospital is an assessment-driven protocol, which utilizes an intensive regimen of standard therapy. The ACP includes: asthma history, clinical and objective assessments, algorithm cues for the next step, a treatment record and discharge criteria. Specific criteria are outlined for decreasing treatment, augmenting treatment for patients that fail to respond, and transferring patients to the intensive care unit (ICU). The ACP has successfully decreased the average length of stay (LOS) from > 3.0 days to 1.8 days. About 16% of ACP admissions require treatment with an intensification protocol for failure to respond / progress. Participants: All children < = 4 years of age admitted to an ACU for asthma from Jan. April 97. Methodology: All asthma admissions were treated using the ACP and swabbed nasally for the presence of RSV. Patients were evaluated as being RSV (+) or RSV (-). The ACP treatment consisted of standard assessment criteria (wheeze, air exchange, accessory muscle usage, SpO_{2} and respiratory rate) and standard therapy (supplemental O_{2}, albuterol aerosols, corticosteroids). Specific (assessment-based) criteria were outlined for decreasing treatment in a stepwise fashion. Patients that failed to respond to this standard therapy were administered an intensification protocol (high-dose albuterol mixed with ipratropium, SC epinephrine and corticosteroids). All patients were immediately admitted into the ACP, and all patients were discharged after receiving 2 aerosols 6 hours apart (q6h). Patients initially admitted to ICU were excluded. Morbidity was measured by phone survey after discharge. Mean values for demographic and outcome variables were compared with t-tests. Percentages by race and gender were compared using a Fisher exact test. Distributions by chronic severity class were compared with the Chi Square test. Results: Demographic and outcome variables are shown in the table as whole numbers percentages, or mean values (SD). Comparing groups by RSV status, there were no differences in demographic variables or in distribution by chronic severity class. There were no deaths or ICU transfers.

RSV (+) RSV (-) p Values

Demographics (n=) 40 34

Age (years) 1.9 2.2 0.11

(0.69) (0.92)

Non Caucasian 91% 79% 0.24

Males 61% 77% 0.63

Severe Chronic Asthma 60% 44% 0.63

Outcomes

Length of Stay (days) 2.18 1.57 < 0.01

(0.79) (0.52)

Aerosol Treatments 12.3 9.4 0.02

(5.9) (3.8)

Patients Intensified (n=) 9 3 0.13

Hospital Cost / Case $1,605 $1,233 < 0.01

($475) ($408)

Post Discharge Morbidity

(days) 3.8 2.3 0.04

(2.6) (2.4)

Conclusions: Asthmatic children < = 4 years of age and RSV (+), have a longer LOS, a higher cost to treat, and a longer post discharge morbidity than those RSV (-). On average, asthmatics that are RSV (+) require more therapy and are intensified at triple the rate as RSV (-) asthmatics.

The 44th International Respiratory Congress Abstracts-On-DiskĀ®, November 7 - 10, 1998, Atlanta, Georgia.

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