Endotracheal intubation and pediatric status asthmaticus: Site of original care affects treatment

Objectives. Status asthmaticus is a common cause of admission to a pediatric intensive care unit (PICU). Children unresponsive to medical therapies may require endotracheal intubation; however, this treatment carries significant risk, and thresholds for intubation vary. Our hypothesis was that children who sought care at community hospitals received less aggressive treatment and more frequent intubation than children who sought care at a children's hospital. Design: Retrospective cohort study. Setting. A university-affiliated children's hospital PICU. Patients: We retrospectively examined data from all children older than 2 yrs admitted to the PICU with status asthmaticus between April 1997 and July 2005. Interventions. None. Measurements and Main Results. Of the 251 children admitted to the PICU with status asthmaticus, 130 initially presented to the emergency department of a children's hospital and 116 presented to the emergency department of a community hospital. Despite similar illness severity, children presenting to a community hospital were significantly more likely to be intubated than those presenting to a children's, hospital (17% vs. 5%; p =.004). In addition, those children intubated at community hospitals were intubated sooner after presentation (2.4 +/- 5.2 vs. 7.5 +/- 5.8 hrs; p =.009), had Shorter durations of intubation (71 +/- 73 vs. 151 +/- 81 hrs; p =.02), and had shorter PICU length of stays (129 +/- 82 vs. 230 +/- 84 hrs; p =.01). Conclusions: Children with status asthmaticus are more likely to be intubated, and intubated sooner, at a community hospital. The shorter duration of intubation suggests that some children may not have been intubated had they presented to a children's hospital or received more aggressive therapy at their community hospital.