Trends in Admissions for Pediatric Status Asthmaticus in New Jersey Over a 15-Year Period
Trends in Admissions for Pediatric Status Asthmaticus in New Jersey Over a 15-Year Period
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DOI：
10.1542/peds.2009-3239
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发表时间：
2010-10-01
期刊：
影响因子：
8
通讯作者：
Watson, R. Scott
中科院分区：
文献类型：
--
作者：
Hartman, Mary E.;Linde-Zwirble, Walter T.;Watson, R. Scott
目的：哮喘持续状态占哮喘相关发病率和死亡率的很大一部分，但我们对其流行病学知之甚少。我们在这里描述了哮喘持续状态儿童的住院特征，他们如何随时间变化，以及有和没有 PICU 的医院之间的差异。 患者和方法：我们使用新泽西州的行政数据，其中包括 1992 年、1995 年和 1999-2006 年该州的所有住院情况。我们通过使用国际疾病分类第九版、表明哮喘持续状态的诊断代码以及通过程序代码使用机械通气来识别患有哮喘持续状态的儿童。我们将设有 PICU 的医院指定为“PICU 医院”，将没有 PICU 的医院指定为“成人医院”。 结果：我们确定了 28 309 名患有哮喘持续状态的儿童入院（占所有哮喘住院患者的 22.8%）。从1992年到2006年，入院率下降了一半（从1000名儿童的1.98名下降到1000名儿童的0.93名），成人医院收治的儿童人数减少了70%。 PICU 医院的 ICU 护理率增加了两倍多。然而，机械通气率仍然较低，死亡人数很少且没有变化（总共 14 例）。医院费用从 660 万美元攀升至 950 万美元。结论：虽然因哮喘持续状态入院的儿童数量减少，但在 PICU 治疗的患者比例正在上升。机械通气率或死亡率没有显着变化。需要进行更多研究，以更好地了解患者和医生如何决定合适的医院护理地点以及该选择如何影响结果。儿科 2010；126：e904-e911
OBJECTIVE: Status asthmaticus accounts for a large portion of the morbidity and mortality associated with asthma, but we know little about its epidemiology. We describe here the hospitalization characteristics of children with status asthmaticus, how they changed over time, and how they differed between hospitals with and without PICUs.PATIENTS AND METHODS: We used administrative data from New Jersey that included all hospitalizations in the state from 1992, 1995, and 1999-2006. We identified children with status asthmaticus by using International Classification of Diseases, Ninth Revision, diagnosis codes that indicate status asthmaticus and the use of mechanical ventilation by using procedure codes. We designated hospitals with a PICU as "PICU hospitals" and those without as "adult hospitals."RESULTS: We identified 28 309 admissions of children with status asthmaticus (22.8% of all asthma hospitalizations). From 1992 to 2006, the rate of hospital admissions decreased by half (from 1.98 in 1000 to 0.93 in 1000 children), and there was a 70% decrease in the number of children admitted to adult hospitals. The rate of ICU care in PICU hospitals more than tripled. However, the rate of mechanical ventilation remained low, and the number of deaths was small and unchanged (n = 14 total). Hospital costs climbed from $6.6 million to $9.5 million.CONCLUSIONS: Although fewer children are being admitted with status asthmaticus, the proportion of patients managed in PICUs is climbing. There has been no substantial change in rates of mechanical ventilation or death. Additional research is needed to better understand how patients and physicians decide on the appropriate site for hospital care and how that choice affects outcome. Pediatrics 2010;126: e904-e911