2000 OPEN FORUM Abstracts
PILOT OF A PEDIATRIC ASTHMA ASSESSMENT-BASED, SCORING SYSTEM AS A PREDICTOR OF HOSPITAL LENGTH OF STAY
Marsha Rogers CRT, Karen Camasso MD, Carolyn Kercsmar MD, Timothy R. Myers BS, RRT, and Robert Chatburn RRT, FAARC. Rainbow Babies & Children's Hospital, Cleveland, OH
Introduction: Asthma is a chronic inflammatory disease of the airways that affects approximately 5 million children. While children represent 1/3 of the asthma population in the United States, they are the fastest growing segment for prevalence. Although asthma is considered an ambulatory sensitive condition, Emergency Department (ED) visits for pediatric asthma is common. ED visits and hospitalization constitutes a failure of ambulatory or preventative care. Approximately 30-40% of our 1600 ED asthma visits result in hospitalization. All asthma patients, regardless of setting, are placed on an assessment-based care paths for treatment (ACP). Patients requiring aerosols more frequently than Q2H on admission are admitted to our pediatric intensive care unit (PICU), and those treated less frequently are admitted to our Asthma Care Unit (ACU). Utilization of our ACP has assisted in decreasing inpatient length of stay (LOS) to 1.9 days for asthma admissions. While this LOS for pediatric asthma is acceptable, 40% of our asthmatics have a LOS > 1.9 days and 16% require treatment intensification (Respir Care 1998, 43(1)) prior to discharge home. We theorize if these subsets could be identified earlier in their admission, that more aggressive care could further shorten LOS. Objective: To determine if an assessment-based pilot scoring system utilized in the ED prior to admission for children in status asthmaticus is predictive of hospital (LOS). Participants: All children, ages 1-16, admitted to our hospital over 3 months that received at least 5 or 6 aerosols in our ED prior to admission. Methodology: All ED patients were treated using our standardized assessment-based ACP. The ACP consists of assessment criteria (wheeze, air exchange, accessory muscle usage, pulse oximetry and respiratory rate) and therapy (O2, albuterol aerosols, steroids) at prescribed intervals. Treatment was discontinued when preset discharge criteria were met. Patients were observed for 1 hour after their last treatment then discharged. Patients not meeting discharge criteria after 6 aerosols or 1 hour of continuous aerosols were admitted. All patients requiring admission were treated using our inpatient ACP (Respir Care 1998, 43(1)). Patients admitted to our PICU were treated with continuous and Q1H aerosols, then placed on the ACP when Q2H aerosol frequency was achieved. For this study, a weighted, numerical scoring system based on our standard ACP assessment criteria was piloted. The pilot score was assessed from each patient's fifth or sixth ED assessment. Scores could range from a low of 2 to a high of 15.
Results: A total of 95 children were enrolled in the study. Retrospective review of the study data indicates that 70 patients met and completed all study criteria (study enrollment, 5 or 6 aerosols on ED ACP, and completion of inpatient ACP). Student t-tests (p<0.05) were utilized to assess assessment score significance to hospital LOS.
|Assessment Score||Avg. Assessment Score||Hospital LOS (SD)||p value|
|> 9 (n= 20)||11.2 (± 1.4)||2.09 (± 0.86)||p=0.01|
|5-9 (n= 29)||7.2 (± 1.3)||1.58 (± 0.55)||p=0.006|
|< 5 (n= 21)||3.4 (± 0.8)||1.29 (± 0.48)||p=0.05|
Conclusion: The ED scoring system developed and piloted in this study appears to be have some predicted statistical value for hospital LOS for children admitted with asthma. Further studies are needed to validate this pilot data.