Hospitals Using More Stringent Criteria to Admit Childhood Asthma Patients

Severe asthma flare-ups nearly doubled in five years

September 07, 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.

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. These findings, from researchers at Children's Hospital at Strong of the University of Rochester, are published in the September issue of the journal Pediatrics, released today. The study, funded by Children's Hospital at Strong, 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.

"It appears that the health-care system in this community has raised the severity threshold for admission," says Kenneth McConnochie, M.D., leader of the group that conducted the study. "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. Nearly 5 million children have asthma in the United States.

Researchers from Children's Hospital at Strong examined the changes in childhood asthma hospitalization rates, and then determined whether children who were hospitalized suffered from mild, moderate, or severe flare-ups of asthma when they were admitted. Using data provided by Rochester Healthcare Information Group Inc., 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." These observed changes in hospitalization criteria might not be exclusive to Rochester, researchers say. It is widely accepted that the burden of asthma on children has increased nationally, however, a number of recent studies have shown that, in many areas of the country, the asthma hospitalization rate has stabilized. These stable rates, despite the increasing severity of asthma, may have been achieved elsewhere in the country by raising the threshold for admission to the hospital.

In addition to McConnochie, the research team at Children's Hospital at Strong consisted of Mark Russo, M.S.; John McBride, M.D.; Peter Szilagyi, M.D.; Ann-Marie Brooks, M.D.; and Klaus Roghmann, Ph.D.

The findings have led these Children's Hospital at Strong colleagues to take a closer look at the causes and care of asthma. "At this point, we can only speculate on why there are many more severe asthma flare-ups," McConnochie says. "Efforts at prevention will be better targeted when we can move beyond speculation. Although physicians in this community have not deliberately raised the admission threshold for asthma, and, indeed, have not been aware of this change until now, plenty of children previously hospitalized are now cared for in the home. We need to learn a lot more about supporting families as they care for those sick children at home."

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