title: How commonly are children hospitalized for asthma eligible for care in alternative settings?
abstract: OBJECTIVE
  To estimate the proportion of children hospitalized for acute asthma exacerbation who might be cared for successfully in alternative settings such as short-stay units or in-home nursing.
  
  
  METHODS
  Descriptive study based on analysis of hospital discharge files and on retrospective medical record review of a random sample of asthma hospitalizations.
  
  
  METHODS
  The 2028 asthma hospitalizations between 1991 and 1995 for children (aged <19 years) dwelling in Rochester, NY, were studied. Measures included the duration of frequent administration of nebulized medication (2 or more times in a 4-hour period), worst oxygen saturation levels, deterioration, and hospital length of stay. Oxygen saturation values and nebulized medication frequency were determined by hospital record review on a random sample of 443 asthma episodes. Length of stay was available for all admissions.
  
  
  RESULTS
  Worst oxygen saturation following hospital admission was 95% or greater, 90% to 94%, and less than 90% for 21.3%, 51.6%, and 27.1% of episodes, respectively. Children received frequent nebulized medication treatments for a mean of 2.0 nursing shifts (8 hours per shift), although they remained hospitalized, on average, for 4.3 nursing shifts longer. Deterioration to a critical level of severity was uncommon. Among children initially admitted to the regular pediatric inpatient unit, only 0.7% subsequently deteriorated to the point that they were transferred to the critical care unit.
  
  
  CONCLUSIONS
  More than 70% of asthma hospitalizations in this community could be cared for in alternative settings with supplemental oxygen, nebulized medication treatments, and close nursing observation provided, in most cases, for 2 nursing shifts.
authors.affiliation: Department of Pediatrics, University of Rochester School of Medicine, NY, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: McConnochie
authors.forename: M J
authors.initials: MJ
authors.lastname: Russo
authors.forename: J T
authors.initials: JT
authors.lastname: McBride
authors.forename: P G
authors.initials: PG
authors.lastname: Szilagyi
authors.forename: A M
authors.initials: AM
authors.lastname: Brooks
authors.forename: K J
authors.initials: KJ
authors.lastname: Roghmann
mesh_terms: D000293:Adolescent; D000336:Aerosols; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000453:epidemiology* / Q000451:nursing / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data*; D006757:Hospital Units / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D009518:New York / Q000453:epidemiology; D010100:Oxygen / Q000097:blood; D010102:Oxygen Inhalation Therapy / Q000706:statistics & numerical data; D012189:Retrospective Studies
chemical_list: D000336:Aerosols; D018927:Anti-Asthmatic Agents; D010100:Oxygen