Risk Factors for Pediatric Asthma Readmissions: A Systematic Review

Alexander H Hogan; Christopher L Carroll; Marissa G Iverson; Jessica P Hollenbach; Kaitlyn Philips; Katarzyna Saar; Tregony Simoneau; Jesse Sturm; Divya Vangala; Glenn Flores

doi:10.1016/j.jpeds.2021.05.015

Risk Factors for Pediatric Asthma Readmissions: A Systematic Review

J Pediatr. 2021 Sep:236:219-228.e11. doi: 10.1016/j.jpeds.2021.05.015. Epub 2021 May 13.

Authors

Affiliations

¹ Division of Hospital Medicine, Connecticut Children's Medical Center, Hartford, CT; Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT. Electronic address: AHogan@connecticutchildrens.org.
² Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT; Division of Critical Care, Connecticut Children's Medical Center, Hartford, CT.
³ University of Connecticut Health Sciences Library, Farmington, CT.
⁴ Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT; Asthma Center, Connecticut Children's Medical Center, Hartford, CT.
⁵ Children's Hospital at Montefiore, Bronx, NY; Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY.
⁶ Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT.
⁷ Boston Children's Medical Center, Boston, MA; Department of Pediatrics, Harvard University, Cambridge, MA.
⁸ Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT; Department of Emergency Medicine, Connecticut Children's Medical Center, Hartford, CT.
⁹ Department of Pediatrics, Duke University, Durham, NC.
¹⁰ Department of Pediatrics, University of Miami Miller School of Medicine, and Holtz Children's Hospital, Jackson Health System, Miami, FL.

PMID: 33991541
DOI: 10.1016/j.jpeds.2021.05.015

Abstract

Objective: To systematically review the literature on pediatric asthma readmission risk factors.

Study design: We searched PubMed/MEDLINE, CINAHL, Scopus, PsycINFO, and Cochrane Central Register of Controlled Trials for published articles (through November 2019) on pediatric asthma readmission risk factors. Two authors independently screened titles and abstracts and consensus was reached on disagreements. Full-text articles were reviewed and inclusion criteria applied. For articles meeting inclusion criteria, authors abstracted data on study design, patient characteristics, and outcomes, and 4 authors assessed bias risk.

Results: Of 5749 abstracts, 74 met inclusion criteria. Study designs, patient populations, and outcome measures were highly heterogeneous. Risk factors consistently associated with early readmissions (≤30 days) included prolonged length of stay (OR range, 1.1-1.6) and chronic comorbidities (1.7-3.2). Risk factors associated with late readmissions (>30 days) included female sex (1.1-1.6), chronic comorbidities (1.5-2), summer discharge (1.5-1.8), and prolonged length of stay (1.04-1.7). Across both readmission intervals, prior asthma admission was the most consistent readmission predictor (1.3-5.4).

Conclusions: Pediatric asthma readmission risk factors depend on the readmission interval chosen. Prior hospitalization, length of stay, sex, and chronic comorbidities were consistently associated with both early and late readmissions.

Trial registration: CRD42018107601.

Keywords: asthma exacerbation; pediatric asthma; rehospitalization; status asthmaticus.

Publication types

Systematic Review

MeSH terms

Adolescent
Asthma / complications
Asthma / epidemiology*
Asthma / therapy
Child
Child, Preschool
Hospitalization*
Humans
Risk Factors