Hospital admissions and readmissions for asthma in the age group 0-4 years.
SUMMARY. Childhood rates for admission and readmission for asthma are highest under the age of 5 years. From a registration study in 0-4-year-olds, 100 patients (68 male) were admitted to hospital for asthma and followed for 1 year, yielding a total of 136 admissions. To examine factors that may play a role in admissions and readmissions, histories and laboratory tests for atopic status at initial presentation, and clinical data on admission were evaluated. Age groups 0-1 year (n = 54) and 2-4 years (n = 46) were analyzed separately, of whom 20 (37%) and 9 (20%) patients, respectively, had at least one readmission. In the age group 2-4 years, patients with antibodies against inhalant allergens, determined by radioallergosorbent test (RAST), had a significantly higher risk of readmission (RR = 1.54; 95% CI, 1.22-1.95). In the age group 0-1, year prevalence of sensitization to inhalant allergens was low (20% vs. 72% in age group 2-4 years) and constituted only a slight risk (P = 0.097) for readmission. A history of eczema showed a negative association in the age group 0-1 year. Treatment of the first admission did not differ between children only admitted once and those requiring readmission. In both age groups, clinical features at admission did not differ significantly between first and subsequent admissions, and neither did length of stay. Number of readmissions were higher in the age group 0-1 year than in the age group 2-4 years (27/81 (33%) vs. 9/55 (16%), P = 0.028), with no indication of a lower threshold for admission. In the age group 0-1 year, 60% of the readmissions occurred within 2 months of first hospitalization. Moreover, in the age group 0-1 year a trend was observed that inhaled steroids were prescribed less frequently on discharge following first admission in those children who were readmitted than in the children who had a first admission only (4/20 (20%) vs. 15/34 (44%), P = 0.073). More "aggressive" therapy with anti-inflammatory drugs and close medical follow-up after discharge seem to be indicated.
Wever-Hess
J
J
Department of Pediatric Respiratory Medicine, Juliana Children's Hospital, Sportlaan 600, 2566 MJ The Hague, The Netherlands.
Hermans
J
J
Kouwenberg
J M
JM
Duiverman
E J
EJ
Wever
A M
AM
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000485:Allergens / Q000276:immunology; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000906:Antibodies / Q000097:blood; D001249:Asthma / Q000276:immunology / Q000503:physiopathology*; D016009:Chi-Square Distribution; D002675:Child, Preschool; D004485:Eczema / Q000145:classification; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D006967:Hypersensitivity / Q000145:classification; D007114:Immunization; D007073:Immunoglobulin E / Q000097:blood; D007223:Infant; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D008487:Medical History Taking; D010343:Patient Admission; D010351:Patient Discharge; D010359:Patient Readmission; D012307:Risk Factors; D018709:Statistics, Nonparametric
D000305:Adrenal Cortex Hormones; D000485:Allergens; D000893:Anti-Inflammatory Agents; D000906:Antibodies; D007073:Immunoglobulin E