Patient origin is associated with duration of endotracheal intubation and PICU length of stay for children with status asthmaticus

Objective: To describe intubation practices and duration of mechanical ventilation in children with status asthmaticus admitted from emergency departments (ERs) to pediatric intensive care units (PICUs). Design: Retrospective cohort study using the Virtual PICU Performance System database (VPS, LLC) of children with status asthmaticus admitted to a participating PICU between December 2003 and September 2006. The primary outcome measure was intubation prior to intensive care unit (ICU) admission. Secondary outcomes included length of intubation and medical length of stay. Setting: Thirty-five PICUs in the United States. Patients: Children who were intubated and mechanically ventilated during their ICU stay for asthma and were admitted from an ER. Results: A total of 4051 patients with status asthmaticus were identified. Intubation data were available from 35 of the 53 centers. Of all, 187 children were intubated for asthma, of which 157 were admitted from an ER and had complete data. Of all, 85 patients were from community hospital ERs and 72 were from the institution's own ER. In all, 115 (73%) patients were intubated prior to ICU admission and 42 (27%) patients were intubated after PICU admission. Of patients who received mechanical ventilation for status asthmaticus and were intubated prior to PICU admission, a greater proportion were intubated at community hospital ERs than in the institutions' own ERs. Eightyfive percent of the patients from community hospital ERs were intubated prior to PICU admission as opposed to 60% from institution's own ERs (P = .0004). However, median duration of intubation and PICU stay from community hospital ERs was significantly shorter than from the hospitals' own ERs (25 vs 42 hours P = .011; 57 vs 98 hours P = .0013, respectively). Logistic regression analysis revealed that after controlling for the effects of age, race, gender, and a revised version of the Paediatric Index of Mortality score of patients who were admitted for status asthmaticus and required mechanical ventilations, patients treated in community hospital ERs represented a greater proportion of preadmission intubation. The odds ratio for preadmission intubation was 5.1 if the patients arrived from community hospital ERs (95% confidence interval 1.91-13.6). Conclusion: Patients with status asthmaticus are more likely to be intubated when they are admitted from community hospital emergency rooms, although the duration of intubation and PICU stay is shorter.