Emergency Department Visits for Asthma Resulting in Hospitalizations Among DC Children and Adolescents: A Population-based Study

Background: Frequent asthma-related emergency department (ED) visits that do not result in hospitalization may be a marker of ED utilization that could be prevented with more effective longitudinal care. We hypothesized that lack of specialist care, low use of primary care, and a low controller to total asthma medication prescription ratio would be associated with lower hospitalization to ED visit ratios among children and adolescents in the District of Columbia (DC).

Methods: All DC children and adolescents aged 2-17 years who made ≥2 ED visits for asthma over a 24-month period (1/1/2018 to 12/31/2019) were identified from the previously validated DC Pediatric Asthma Registry (N=1,298 or 9.2% of all children in Registry). We derived each participant’s hospitalization to ED visit ratio (HE ratio) during the study period and divided them into three groups: low HE ratio (0), moderate HE ratio (0.01 – 0.5), and high HE ratio (0.51 – 1). The primary independent variable was specialist contact in the prior 24 months (no contact vs at least one visit with a pulmonologist or allergist). Secondary independent variables included primary care contact in prior 24 months ( <2, 2, or >2 visits); controller to total asthma medication prescription ratio (CAM ratio); asthma severity (intermittent vs persistent); and sociodemographic factors (age, sex, race/ethnicity, insurance status). Using multivariable logistic regression models, we estimated the adjusted odds ratio (adjOR) for the association between HE ratio and each variable.

Results: Participants were predominantly black (85.1%), male (59.8%), aged ≥ 6 years (54.6%), and publicly insured (66.3%). Most patients had a low HE ratio (70.9%) and 55.8% had no specialist contact (Table 1). In adjusted models, the odds of having a low HE ratio were significantly higher among those who had no specialist contact when compared both to those with a moderate HE ratio (adjOR = 1.84, 95% CI=1.37 – 2.47, p<0.01) and a high HE ratio (adjOR=2.21, 95% CI=1.27 – 3.85, p<0.001). Low CAM ratio, intermittent asthma, age ≥ 6years; and black race were all significantly associated with a low HE ratio compared to a high HE ratio (Table 2). In a subgroup analysis stratified by asthma severity, the association between HE ratio and specialist contact remained significant among those with persistent asthma but not among those with intermittent asthma.

Conclusion: Among DC children and adolescents with asthma, lack of contact with a specialist and a low CAM ratio were associated with lower HE ratio (a pattern of frequent ED visits that did not result in hospital admission). Involving pulmonologists or allergists in asthma care and efforts to achieve better asthma control may result in less non-emergent asthma-related ED utilization.