Risk Factors Associated With Escalation of Therapy in Hospitalized Children With Asthma.
Complex chronic conditions linked to more than double the odds of asthma therapy escalation
Risk Factors Associated With Escalation of Therapy in Hospitalized Children With Asthma.
Children hospitalized for asthma exacerbations may require escalation of therapy (escalation of therapy), but risk factors remain poorly defined.
We aimed to identify risk factors for escalation of therapy to inform interventions and improve care.
We conducted a retrospective cohort study using the Pediatric Health Information System of hospitalized children aged 4 to 18 years with a diagnosis of an asthma exacerbation from January 1, 2018, to December 31, 2023, across 45 children's hospitals.
kids with complex chronic conditions had more than double the odds of escalation
Among 92 224 encounters, 15 989 (17.34%) required escalation of therapy.
Adjusted analysis showed lower odds of escalation of therapy in male patients (adjusted odds ratio [aOR], 0.91 [CI, 0.88, 0.94]) and spring compared with summer admissions (aOR, 0.93 [0.88, 0.99]).
Compared with early childhood (<5 years), the odds of escalation of therapy were higher in late childhood (5-12 years) (aOR, 1.19 [1.13, 1.26]), adolescence (13-17 years) (aOR, 1.48 [1.38, 1.59]), and adults (≥18 years) (aOR, 1.43 [1.17, 1.73]).
Child Opportunity Index and insurance were not significantly associated with escalation of therapy.
We identified key risk factors for escalation of therapy in children hospitalized for asthma exacerbations. Such findings can help with early risk stratification or serve as proxies for modifiable features of inpatient care.
Further research is warranted to explore these associations to improve care.