Association of center volume with outcomes in critically ill children with acute asthma.
BACKGROUND
Little is known about the relation between center volume and outcomes in children requiring intensive care unit (ICU) admission for acute asthma.


OBJECTIVE
To evaluate the association of center volume with the odds of receiving positive pressure ventilation and length of ICU stay.


METHODS
Patients 2 to 18 years of age with the primary diagnosis of asthma were included (2009-2012). Center volume was defined as the average number of mechanical ventilator cases per year for any diagnoses during the study period. In multivariable analysis, the odds of receiving positive pressure ventilation (invasive and noninvasive ventilation) and ICU length of stay were evaluated as a function of center volume.


RESULTS
Fifteen thousand eighty-three patients from 103 pediatric ICUs with the primary diagnosis of acute asthma met the inclusion criteria. Seven hundred fifty-two patients (5%) received conventional mechanical ventilation and 964 patients (6%) received noninvasive ventilation. In multivariable analysis, center volume was not associated with the odds of receiving any form of positive pressure ventilation in children with acute asthma, with the exception of high- to medium-volume centers. However, ICU length of stay varied with center volume and was noted to be longer in low-volume centers compared with medium- and high-volume centers.


CONCLUSIONS
In children with acute asthma, this study establishes a relation between center volume and ICU length of stay. However, this study fails to show any significant relation between center volume and the odds of receiving positive pressure ventilation; further analyses are needed to evaluate this relation in more detail.
Division of Pediatric Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Division of Pediatric Cardiology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas. Electronic address: pgupta2@uams.edu.
Punkaj
P
Gupta
Division of Biostatistics, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Xinyu
X
Tang
Division of Biostatistics, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Jeffrey M
JM
Gossett
Virtual PICU Systems, LLC, Los Angeles, California.
Christine M
CM
Gall
Virtual PICU Systems, LLC, Los Angeles, California.
Casey
C
Lauer
Virtual PICU Systems, LLC, Los Angeles, California; Division of Pediatric Critical Care, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.
Tom B
TB
Rice
Division of Pediatric Critical Care, Department of Pediatrics, Connecticut Children's Medical Center, Hartford, Connecticut.
Christopher L
CL
Carroll
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Robert M
RM
Kacmarek
Virtual PICU Systems, LLC, Los Angeles, California; Division of Critical Care Medicine, Department of Pediatrics and Anesthesiology, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, California.
Randall C
RC
Wetzel
D000293:Adolescent; D001249:Asthma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D017050:Episode of Care; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D016017:Odds Ratio; D012121:Respiration, Artificial / Q000379:methods / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States