title: Secondhand smoke exposure, illness severity, and resource utilization in pediatric emergency department patients with respiratory illnesses.
abstract: OBJECTIVE
  Hospital-based data reveal that children who have secondhand smoke exposure (SHSe) experience severe respiratory illnesses and greater resource utilization. Our objective was to assess the relationship between SHSe and illness severity/resource utilization among children presenting to the pediatric emergency department (PED) with three common respiratory conditions-asthma, bronchiolitis, and pneumonia.
  
  
  METHODS
  A retrospective review of a yearlong consecutive sample of PED patients with SHSe status documentation and asthma, bronchiolitis, or pneumonia diagnoses was performed. PED illness severity/resource utilization variables included triage categorization, initial oxygen saturation, evaluation/testing (influenza A & B, respiratory syncytial virus, chest X-ray), procedures/interventions performed (supplemental oxygen, suctioning, intubation), medications administered, and disposition. Logistic and linear regression models were conducted to determine differences in each diagnosis group while controlling for sociodemographics, medical history, seasonality, and insurance type.
  
  
  RESULTS
  There were 3,229 children with documentation of SHSe status and an asthma (41%), bronchiolitis (36%), or pneumonia (23%) diagnosis. Across diagnosis groups, approximately 1/4 had positive documentation of SHSe. Asthmatic children with SHSe were more likely to receive corticosteroids (odds ratio (OR) = 1.71, 95% confidence interval (CI) = 1.19, 2.44) and/or magnesium sulfate (OR = 1.66, 95% CI = 1.14, 2.40). Children with SHSe and bronchiolitis were more likely to receive racemic epinephrine (OR = 2.48, 95% CI = 1.21, 5.08), have a chest X-ray (OR = 1.36, 95% CI = 1.00, 1.85), and/or be admitted (OR = 1.46, 95% CI = 1.09, 1.95). No differences in illness severity/resource utilization were identified for children with pneumonia.
  
  
  CONCLUSIONS
  SHS-exposed children with asthma or bronchiolitis have greater illness severity/resource utilization. Our findings highlight the importance of SHSe assessment, cessation, and research efforts in the PED setting.
authors.affiliation: a School of Human Services, University of Cincinnati , Cincinnati , OH , USA.
authors.forename: Ashley L
authors.initials: AL
authors.lastname: Merianos
authors.affiliation: b Department of Pediatrics , Kaiser Permanente , Denver , CO , USA.
authors.forename: Cinnamon A
authors.initials: CA
authors.lastname: Dixon
authors.affiliation: c Division of Emergency Medicine , Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati , Cincinnati , OH , USA.
authors.forename: E Melinda
authors.initials: EM
authors.lastname: Mahabee-Gittens
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000191:economics / Q000503:physiopathology; D001988:Bronchiolitis / Q000191:economics / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D010100:Oxygen / Q000097:blood; D011014:Pneumonia / Q000191:economics / Q000503:physiopathology; D012140:Respiratory Tract Diseases / Q000191:economics* / Q000503:physiopathology* / Q000628:therapy; D012189:Retrospective Studies; D012621:Seasons; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D014028:Tobacco Smoke Pollution; D010100:Oxygen
keywords: Admission; bronchiolitis; environmental tobacco exposure; health care utilization; pneumonia; tobacco abuse