Kate Johnson

November 17, 2015

SAN ANTONIO — For children, a visit to the emergency department for an asthma attack is a red flag for future acute-care visits, and could be used to identify patients who might benefit from intervention by an asthma specialist, new research suggests.

"Existing models to stratify patients' risk of future exacerbations are often difficult to incorporate into a busy clinical practice," said Jill Hanson, MD, from Children's Mercy Hospital in Kansas City, Missouri.

"Our model provides a simple and practical tool to identify asthmatic patients at high risk of future healthcare utilization so that resources can be allocated in a cost-effective manner," she explained here the American College of Allergy, Asthma & Immunology 2015 Annual Scientific Meeting.

The retrospective study involved 10,785 asthma patients 3 to 17 years of age. About half were seen in a primary care setting from January 2010 to December 2012, and about half were seen in an allergy or pulmonary clinic.

Acute-care visits were defined as visits to the emergency department or urgent care, or inpatient admission for asthma.

The researchers assessed asthma-related acute-care visits in the previous year and the likelihood of acute-care visits in the future.

"With each additional historic acute-care visit, there was an increased probability of a future acute-care visit, from about 30% with one historic visit to nearly 90% with five or more visits," Dr Hanson said. This was true even after adjustment for age, race, and insurance type.

Table. Previous Acute-Care Visits and the Odds of Future Visits

Number of Visits Previous-Year Visits, % Adjusted Odds Ratio for Future Visits
0 75.2
1 15.5 3.60
2 5.4 7.14
3 1.9 11.89
4 0.8 26.12
5 or more 1.1 58.71


"Reducing the burden of childhood asthma requires a coordinated multidisciplinary approach, which includes medication management and home-based interventions. Unfortunately, resources can be limited, so deciding which patients get these important services can be challenging," said Dr Hanson.

"We are using this model in our institution to identify patients for entry into a high-risk asthma protocol," she explained. If patients have had three or more acute-care visits, "our plan is to follow them to see if their outcomes improve."

The high-risk protocol involves a social and environmental health assessment and a medical consultation by a specialist in either pulmonology or allergy.

"Many children and their families are either not getting this kind of advice, or are not understanding or absorbing it," said Chitra Dinakar, MD, also from Children's Mercy Hospital, who was not involved in the study.

Or, it could be that they are "simply not making a follow-up appointment with a specialist or even their primary care provider, as recommended," she told Medscape Medical News.

Dr Hanson and Dr Dinakar have disclosed no relevant financial relationships.

American College of Allergy, Asthma & Immunology (ACAAI) 2015 Annual Scientific Meeting: Abstract 20. Presented November 8, 2015.


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