title: Emergency department revisits for pediatric acute asthma exacerbations: association of factors identified in an emergency department asthma tracking system.
abstract: OBJECTIVE
  To identify clinical variables associated with a greater likelihood of emergency department (ED) revisit for acute asthma within 7 days after an initial ED visit for acute asthma exacerbation.
  
  
  METHODS
  Cross-sectional study of subjects from a prospectively enrolled cohort of children aged 0 to 18 years with physician-diagnosed asthma in the ED Allies Tracking System. Demographics and data on quality of life, health care utilization, environmental factors, chronic asthma severity, and ED management were collected. Emergency department revisits for acute asthma within 7 days of a prior visit resulting in discharge were compared with those without a revisit, using chi2 and t tests and logistic regression.
  
  
  RESULTS
  Four thousand two hundred twenty-eight ED asthma visits were enrolled; 3276 visits resulted in discharge. Persistent asthma was identified in 66% of visits. Emergency department revisits within 7 days of a prior visit occurred following 133 (4.1%) visits. There were no significant differences in environmental factors or ED management between visits with and without an ED revisit. In univariate analysis factors associated with a greater revisit likelihood included age younger than 2 years, black race or Hispanic ethnicity, persistent asthma, public insurance, lower quality of life, and greater health care utilization in the prior 12 months. Variables independently significant (P < 0.05) in logistic regression were chronic asthma severity classified as persistent, age younger than 2 years, and lower asthma quality of life.
  
  
  CONCLUSIONS
  Although our design precludes drawing causal inference, our results suggest that children younger than 2 years or with persistent asthma or lower asthma quality-of-life scores are at greater risk for ED revisits after acute ED asthma care.
authors.affiliation: Department of Pediatrics, Children's Mercy Hospital and University of Missouri Kansas City, Kansas City, MO 64108, USA. cwalshkelly@mh.edu
authors.forename: Christine M
authors.initials: CM
authors.lastname: Walsh-Kelly
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Kelly
authors.forename: Amy L
authors.initials: AL
authors.lastname: Drendel
authors.forename: Laura
authors.initials: L
authors.lastname: Grabowski
authors.forename: Evelyn M
authors.initials: EM
authors.lastname: Kuhn
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000555:Ambulatory Care Information Systems / Q000706:statistics & numerical data*; D001249:Asthma / Q000453:epidemiology* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016347:Medical Records Systems, Computerized; D011788:Quality of Life; D012008:Recurrence; D014922:Wisconsin / Q000453:epidemiology