Long-term asthma-related readmissions: comparison between children admitted and not admitted to the intensive care unit for critical asthma

To compare the time to asthma-related readmission between children admitted to the intensive care unit (ICU) for asthma and those with a non-ICU hospitalization in the United States and to explore risk factors associated with readmission among children admitted in the ICU. In this retrospective cohort study, we included children aged 2–17 years in the State Inpatient Database (2005-2014) from four U.S. states who were hospitalized for asthma. We compared the time to asthma-related readmissions and emergency department (ED) visit between children admitted and not admitted to the ICU using the log-rank test. Among those admitted to the ICU, we explored factors associated with readmission using Cox regression. 66 835 children were hospitalized for asthma, with 14.0% admitted to the ICU, and 12 844 were readmitted for asthma while 22 915 had an asthma-related ED visit. The time to asthma-related readmission was shorter in the ICU group compared to the non-ICU group (<i>p</i> p = 0.43). Being preschool-aged, female, Black, and having lower household income and a longer length of stay during the initial hospitalization conferred a higher risk of asthma-related readmission among children admitted to the ICU. Preschool age and Medicaid were Florida-specific risk factors while Hispanic ethnicity was New York-specific. Compared to children not admitted to the ICU, children admitted to the ICU for asthma were at increased risk of asthma-related readmission, with certain risk factors conferring an even higher risk.

本研究旨在对比美国因哮喘入住重症监护病房（Intensive Care Unit，ICU）与非ICU住院的儿童的哮喘相关再住院时间，并探索ICU收治儿童再住院的相关危险因素。
本项回顾性队列研究纳入了2005-2014年美国4个州的州住院患者数据库中年龄2~17岁、因哮喘住院的儿童。研究采用对数秩检验对比了ICU与非ICU收治儿童的哮喘相关再住院时间及急诊部门（Emergency Department，ED）就诊情况。针对ICU收治的儿童，本研究采用Cox回归分析探讨其再住院的相关影响因素。
本研究共纳入66835名因哮喘住院的儿童，其中14.0%入住了ICU；共有12844名儿童因哮喘再次住院，22915名儿童因哮喘相关病因就诊于ED。ICU组儿童的哮喘相关再住院时间短于非ICU组（*p*=0.43）。
在ICU收治的儿童中，学龄前年龄、女性、黑人种族、较低的家庭收入以及初次住院时长更长，均与哮喘相关再住院风险升高相关。学龄前年龄与医疗补助（Medicaid）为佛罗里达州特有的危险因素，而西班牙裔种族为纽约州特有的危险因素。
与非ICU收治的哮喘儿童相比，ICU收治的哮喘儿童发生哮喘相关再住院的风险更高，且部分危险因素会进一步升高该风险。