Researchers score big with nationally published studies
Brighton, Pittsford residents did much of the legwork
October 01, 1999
While the number of childhood asthma sufferers being admitted to all Rochester-area hospitals remained stable between 1991 and 1995, those who were admitted more recently suffered from more severe flare-ups of asthma. So says the findings from a study conducted at Children's Hospital at Strong. Several researchers who live in the Brighton-Pittsford area were involved in the study, published in the most recent issue of the journal Pediatrics.
The report suggests that some children who were hospitalized for asthma in 1991 would not have been admitted in 1995 had they visited the hospital with the same type of flare-up in their asthma, said Dr. Kenneth McConnochie, of Pittsford. When comparing cases of children who were hospitalized for asthma during this five-year period, the percentage of children with severe episodes increased steadily, rising from 31.5 percent in 1991 to 60.4 percent in 1995. Conversely, the percentage of children with mild episodes of asthma decreased from 14.1 percent to 4.7 percent during the same time.
"It appears that the health-care system in this community has raised the severity threshold for admission," McConnochie said. "In other words, children who now stay overnight in the hospital for asthma are, on average, sicker."
The findings are based on a study of 2,028 Monroe County children who suffered from asthma that was so serious it caused them to be hospitalized between 1991 and 1995. Researchers discovered that the criteria used by hospitals to determine whether an asthma sufferer should be admitted - or treated and sent home - has become more stringent.
"This study offers both good and bad news," McConnochie says. "Perhaps because of better communication or medicine, it appears that families and physicians in this community have learned how to take care of many asthma flare-ups in the child's own home that previously would have been cared for in the hospital.
"I believe most families would rather care for their sick child at home, when possible, because hospitalization is stressful not only for the child, but for the entire family," McConnochie adds. "The good news is that more children with asthma are being cared for at home. The bad news is the incidence of severe asthma flare-ups has nearly doubled in just a 5-year period." McConnochie's research partners were Mark Russo; Dr. John McBride; Dr. Peter Szilagyi, of Pittsford; Dr. Ann-Marie Brooks; and Klaus Roghmann, of Brighton.
Another Pittsford man - Dr. Jeffrey Rubenstein, who works at Children's Hospital at Strong - also had research published nationally. He teamed with Dr. Karen Powers to study 16 parents who were invited to stay with their child and watch, for example, as doctors inserted chest tubes, breathing tubes, and central venous catheters.
The pair concluded that parents who are allowed to stay in their child's hospital room during medical procedures are less anxious about the process, although their concern about the child's condition remains the same. The findings are published in the most recent issue of Archives of Pediatrics & Adolescent Medicine.
Parents have traditionally been asked to leave during invasive procedures in the pediatric intensive care unit. Although many experienced pediatricians are comfortable having a parent observe some medical procedures, it is standard practice for parents to be asked to go to the waiting room.
In this study, almost all parents thought their presence was a comfort to their child. Many found that the procedure was less intimidating than what they had imagined. In fact, no parents left the room while the procedures were being performed, despite clear opportunities to do so. Fifteen of the 16 parents said they would repeat their choice to watch.
"They weren't sitting in the waiting room, wondering what was taking so long," Powers says. 'They weren't sitting there with nothing to do but let their imagination run wild. Instead, they were right there with us, and they had the chance to see how hard people were working, how much effort they gave to try to help their child."