FACTORS ASSOCIATED WITH PROLONGED HOSPITALIZATION OF CHILDREN WITH ASTHMA

Objective: To identify clinical features of asthma present before arrival in the emergency department, at the time of emergency department treatment, and during hospitalization that differ between children with asthma hospitalized for a prolonged period and those hospitalized for an average duration. Design: Retrospective chart review. Patients and Setting: Hospital records of patients with asthma (International Classification of Diseases, Ninth Revision, code 493) admitted to Children's Hospital and Medical Center, Seattle, Wash, from October 1989 to September 1991. Results: The medical records of 23 children hospitalized from October 1989 to September 1991 for more than 4 days with acute asthma were compared with those of 62 sex- and age-matched children hospitalized for 2 days. Patients in the long-stay and short-stay groups had similar histories of home medication use. The presence of asthma symptoms before arrival in the emergency de-partment was prolonged in the long-stay group (P<.001). Only one of the 23 patients in the long-stay group had augmented asthma treatment within 24 hours before hospitalization, compared with 39 of the 62 patients with short stays (P<.001). During hospitalization, a greater proportion of children in the long-stay group than the short-stay group received supplemental oxygen (P<.01). More children in the long-stay group than the short-stay group had residual hypoxemia (arterial oxygen saturation, <94%) in room air at discharge, suggesting that hospital stay was not prolonged to reach normal oxygen saturations. None of the children were readmitted within 1 month of their index admission. Conclusions: Early augmentation of home therapy for acute asthma is associated with a reduced duration of hospitalization for children admitted with asthma. In addition, hypoxemia in children with acute asthma on presentation and during hospitalization is associated with prolonged hospital stay.