Treatment patterns and frequency of key outcomes in acute severe asthma in children: a Paediatric Research in Emergency Departments International Collaborative (PREDICT) multicentre cohort study

RationaleSevere acute paediatric asthma may require treatment escalation beyond systemic corticosteroids, inhaled bronchodilators and low-flow oxygen. Current large asthma datasets report parenteral therapy only.ObjectivesTo identify the use and type of escalation of treatment in children presenting...

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Published in:BMJ open respiratory research 2022-03, Vol.9 (1), p.e001137
Main Authors: Craig, Simon, Powell, Colin V E, Nixon, Gillian M, Oakley, Ed, Hort, Jason, Armstrong, David S, Ranganathan, Sarath, Kochar, Amit, Wilson, Catherine, George, Shane, Phillips, Natalie, Furyk, Jeremy, Lawton, Ben, Borland, Meredith L, O’Brien, Sharon, Neutze, Jocelyn, Lithgow, Anna, Mitchell, Clare, Watkins, Nick, Brannigan, Domhnall, Wood, Joanna, Gray, Charmaine, Hearps, Stephen, Ramage, Emma, Williams, Amanda, Lew, Jamie, Jones, Leonie, Graudins, Andis, Dalziel, Stuart, Babl, Franz E
Format: Article
Language:English
Subjects:
Asthma
Asthma - drug therapy
Australia - epidemiology
Child
Child, Preschool
Children & youth
Cohort analysis
Cohort Studies
Collaboration
Emergency medical care
Emergency Service, Hospital
Female
Hospitals
Humans
Infant
Intensive care
Intravenous therapy
Intubation
Male
Medical records
paediatric asthma
Pediatrics
Retrospective Studies
Steroids
Variance analysis
Ventilators
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Summary:RationaleSevere acute paediatric asthma may require treatment escalation beyond systemic corticosteroids, inhaled bronchodilators and low-flow oxygen. Current large asthma datasets report parenteral therapy only.ObjectivesTo identify the use and type of escalation of treatment in children presenting to hospital with acute severe asthma.MethodsRetrospective cohort study of children with an emergency department diagnosis of asthma or wheeze at 18 Australian and New Zealand hospitals. The main outcomes were use and type of escalation treatment (defined as any of intensive care unit admission, nebulised magnesium, respiratory support or parenteral bronchodilator treatment) and hospital length of stay (LOS).Measurements and main resultsOf 14 029 children (median age 3 (IQR 1–3) years; 62.9% male), 1020 (7.3%, 95% CI 6.9% to 7.7%) had treatment escalation. Children with treatment escalation had a longer LOS (44.2 hours, IQR 27.3–63.2 hours) than children without escalation 6.7 hours, IQR 3.5–16.3 hours; p
ISSN:2052-4439
2052-4439
DOI:10.1136/bmjresp-2021-001137