title: Underuse of guideline-recommended long-term asthma management in children hospitalized to the intensive care unit: a multicenter observational study.
abstract: BACKGROUND
  Despite the significant burden of childhood asthma, little is known about prevention-oriented management before and after hospitalizations for asthma exacerbation.
  
  
  OBJECTIVE
  To investigate the proportion and characteristics of children admitted to the intensive care unit (ICU) for asthma exacerbation and the frequency of guideline-recommended outpatient management before and after the hospitalization.
  
  
  METHODS
  A 14-center medical record review study of children aged 2 to 17 years hospitalized for asthma exacerbation during 2012-2013. Primary outcome was admission to the ICU; secondary outcomes were 2 preventive factors: inhaled corticosteroid (ICS) use and evaluation by asthma specialists in the pre- and posthospitalization periods.
  
  
  RESULTS
  Among 385 children hospitalized for asthma, 130 (34%) were admitted to the ICU. Risk factors for ICU admission were female sex, having public insurance, a marker of chronic asthma severity (ICS use), and no prior evaluation by an asthma specialist. Among children with ICU admission, guideline-recommended outpatient management was suboptimal (eg, 65% were taking ICSs at the time of index hospitalization, and 19% had evidence of a prior evaluation by specialist). At hospital discharge, among children with ICU admission who had not previously used controller medications, 85% were prescribed ICSs. Furthermore, 62% of all children with ICU admission were referred to an asthma specialist during the 3-month posthospitalization period.
  
  
  CONCLUSIONS
  In this multicenter study of US children hospitalized with asthma exacerbation, one-third of children were admitted to the ICU. In this high-risk group, we observed suboptimal pre- and posthospitalization asthma care. These findings underscore the importance of continued efforts to improve prevention-oriented asthma care at all clinical encounters.
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: khasegawa1@partners.org.
authors.forename: Kohei
authors.initials: K
authors.lastname: Hasegawa
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Jason
authors.initials: J
authors.lastname: Ahn
authors.affiliation: Banner University Medical Center, Tucson, Arizona.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Brown
authors.affiliation: The University of Chicago Medicine, Chicago, Illinois.
authors.forename: Valerie G
authors.initials: VG
authors.lastname: Press
authors.affiliation: Novartis Pharmaceuticals, East Hanover, New Jersey.
authors.forename: Susan
authors.initials: S
authors.lastname: Gabriel
authors.affiliation: Novartis Pharmaceuticals, East Hanover, New Jersey.
authors.forename: Vivian
authors.initials: V
authors.lastname: Herrera
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Jane C
authors.initials: JC
authors.lastname: Bittner
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D000293:Adolescent; D000486:Allergy and Immunology; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007073:Immunoglobulin E / Q000032:analysis; D007297:Inpatients / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D014481:United States
chemical_list: D018927:Anti-Asthmatic Agents; D007073:Immunoglobulin E