title: Endotracheal intubation and pediatric status asthmaticus: site of original care affects treatment.
abstract: OBJECTIVE
  Status asthmaticus is a common cause of admission to a pediatric intensive care unit (PICU). Children unresponsive to medical therapies may require endotracheal intubation; however, this treatment carries significant risk, and thresholds for intubation vary. Our hypothesis was that children who sought care at community hospitals received less aggressive treatment and more frequent intubation than children who sought care at a children's hospital.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A university-affiliated children's hospital PICU.
  
  
  METHODS
  We retrospectively examined data from all children older than 2 yrs admitted to the PICU with status asthmaticus between April 1997 and July 2005.
  
  
  METHODS
  None.
  
  
  RESULTS
  Of the 251 children admitted to the PICU with status asthmaticus, 130 initially presented to the emergency department of a children's hospital and 116 presented to the emergency department of a community hospital. Despite similar illness severity, children presenting to a community hospital were significantly more likely to be intubated than those presenting to a children's hospital (17% vs. 5%; p = .004). In addition, those children intubated at community hospitals were intubated sooner after presentation (2.4 +/- 5.2 vs. 7.5 +/- 5.8 hrs; p = .009), had shorter durations of intubation (71 +/- 73 vs. 151 +/- 81 hrs; p = .02), and had shorter PICU length of stays (129 +/- 82 vs. 230 +/- 84 hrs; p = .01).
  
  
  CONCLUSIONS
  Children with status asthmaticus are more likely to be intubated, and intubated sooner, at a community hospital. The shorter duration of intubation suggests that some children may not have been intubated had they presented to a children's hospital or received more aggressive therapy at their community hospital.
authors.affiliation: Pediatric Critical Care, Connecticut Children's Medical Center, Hartford, CT, USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Carroll
authors.forename: Sharon R
authors.initials: SR
authors.lastname: Smith
authors.forename: Melanie S
authors.initials: MS
authors.lastname: Collins
authors.forename: Anita
authors.initials: A
authors.lastname: Bhandari
authors.forename: Craig M
authors.initials: CM
authors.lastname: Schramm
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Zucker
mesh_terms: D016009:Chi-Square Distribution; D002648:Child; D005260:Female; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013224:Status Asthmaticus / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome