Diastolic hypotension key predictor of admission in pediatric asthma

By Helen Albert, Senior medwireNews Reporter

Results from a large study show that diastolic hypotension is a consistent predictor of admission to hospital in all children with asthma.

Other factors, such as tachypnea, tachycardia, hypoxemia, and hypothermia or fever, also predicted admission, but only in specific age groups.

As reported in Pediatric Emergency Care, Timothy Horeczko and Garen Wintemute (University of California Davis School of Medicine, Sacramento, USA) reviewed data collected on 2,454,983 emergency department (ED) visits by children with asthma aged 1-18 years to assess factors associated with admission.

To evaluate if these factors are age specific, the researchers divided the admissions into four age groups: 1-3 years, 3-6 years, 6-12 years, and 12-18 years.

They found that the only significant factor across all age groups was diastolic hypotension. However, this factor was a much greater predictor of admission in the 1-3 years and 3-6 years age groups, at odds ratios (ORs) of 6.27 and 17.95, respectively, than in the 6-12 years and 12-18 years age groups, at ORs of 1.10 and 1.29.

Horeczko and Wintemute speculate that diastolic hypotension in these children could be caused by an unknown comorbidity resulting in widened pulse pressure, such as anemia or heart disease, but is most likely due to recent substantial albuterol use prior to visiting the ED and therefore may simply be a marker of sicker children.

Regarding other age-specific factors, tachycardia was a significant predictor of hospital admission in the 1-3 years and 12-18 years age groups, at ORs of 2.40 and 20.33, respectively, whereas tachypnea predicted admission in the 1-3 years, 3-6 years, and 6-12 years age groups, at respective ORs of 1.04, 47.30, and 2.48.

Hypothermia or fever predicted admission in the 1-3 years, 6-12 years, and 12-18 years age groups, at ORs of 2.06, 3.73, and 6.84, respectively, but not in the 3-6 years age group.

Systolic hypotension was a predictor for admission in the 6-12 years group, increasing the risk 1.66-fold, while hypoxemia increased the risk for admission in the 12-18 years group 1.10-fold.

"This study shows the importance of age-specific assessment in the evaluation of acute asthma or reactive airway exacerbation," conclude the authors.

"These early predictors may have potential implications for hospital-based quality improvement, resource use, and throughput benchmarks."

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