Prospective study of sudden-onset asthma exacerbations in children.
OBJECTIVE
Sudden-onset asthma exacerbations among adults have more rapid treatment responses than do slower-onset exacerbations. We hypothesized that a similar pattern would be evident in children presenting to the emergency department (ED) with an asthma exacerbation.


METHODS
Prospective cohort study at 44 North American EDs. Parents of children, aged 2 to 17 years, underwent a structured interview in the ED and follow-up interview by telephone 2 weeks later.


RESULTS
Of 1184 enrolled children, 11% had sudden-onset asthma (ED presentation < or = 3 hours after symptom onset). Sudden-onset patients were older than slower-onset patients (8.9 vs. 7.7 years, respectively; P = 0.004) and more likely to be white (26% vs. 17%, P = 0.01). They were less likely to report a history of steroid use or asthma hospitalization and reported fewer ED asthma visits during the past year (all P < 0.05). Although initial pulmonary index scores were similar (4.0 vs. 4.3, P = 0.24), patients with sudden-onset asthma were less likely to receive steroid treatment (73% vs. 84%, P = 0.002), had shorter ED length of stay (128 minutes vs. 150 minutes, P = 0.01), and in unadjusted analyses, were less likely to be admitted (16% vs. 24%, P = 0.04).


CONCLUSIONS
Patients with sudden-onset exacerbations had similar acute asthma severity as those with slower-onset exacerbations but had shorter ED length of stay and were less likely to be admitted to the hospital, suggesting a more rapid response to treatment.
Division of Emergency Medicine, Childrens Hospital Los Angeles, Los Angeles, CA 90027, USA. hsedik@chla.usc.edu
Hanan A
HA
Sedik
R Graham
RG
Barr
Sunday
S
Clark
Carlos A
CA
Camargo
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001249:Asthma / Q000145:classification / Q000188:drug therapy / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D015337:Multicenter Studies as Topic; D011446:Prospective Studies; D012720:Severity of Illness Index
D000305:Adrenal Cortex Hormones