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Factors Associated With First Medication Time for Children Treated in the Emergency Department for Asthma

Jang, Hoon PhD*; Ozkaynak, Mustafa PhD; Ayer, Turgay PhD; Sills, Marion R. MD, MPH§

doi: 10.1097/PEC.0000000000001609
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Objectives Acute asthma exacerbations are among the most common reasons for childhood emergency department (ED) visits and hospitalizations. Although early ED administration of asthma medication has been shown to decrease hospitalizations, studies of factors associated with early ED asthma medication delivery have been limited. The objective of our study was to identify patient- and ED-related factors associated with early medication delivery among children treated in the ED for asthma exacerbations.

Methods This retrospective study used electronic health record data from all encounters for a primary diagnosis of asthma in an academic children's hospital ED during the study period 2009 to 2013. Using multivariate logistic regression, we identified the association between patient- and ED-related factors and the time to first medication defined as a binary outcome using a threshold of 1 hour from ED arrival. We then stratified our analysis by triage level (Emergency Severity Index [ESI]).

Results Of the 4846 encounters during the study period, 62% were male, mean age was 7.30 years, 76% had public insurance, and 57% had an ESI level of 3. Medication was administered within 1 hour of arrival in 2236 encounters (46%). After adjusting for covariates, multivariate logistic regression revealed that patients were less likely to have medications within 1 hour when they had less severe ESI (ESI 2 vs ESI 4: odds ratio [OR], 0.139; confidence interval [CI], 0.114–0.170), arrived via non–emergency medical services (OR, 0.525; CI, 0.413–0.665), or arrived to a crowded ED (OR, 0.574; CI, 0.505–0.652). Age, sex, and insurance type were not associated with timeliness of initial medication administration. Stratified analyses demonstrated that the crowding effect was larger for less severely ill patients.

Conclusions Our study found that patient severity (acuity level, arrival mode) and level of ED crowing—but not demographic factors—are associated with the administration of medication in the first hour to pediatric patients with asthma. Our findings may be helpful in redesigning asthma care management strategies.

From the *Science and Technology Policy Institute, Sejong, South Korea;

School of Nursing, University of Colorado-Anschutz Medical Campus, Aurora, CO;

Georgia Institute of Technology, Atlanta, GA; and

§School of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO.

Reprints: Marion R. Sills, MD, MPH, Department of Pediatrics and Emergency Medicine, University of Colorado School of Medicine, 13123 E 16th Ave, B-215, Aurora, CO (e-mail: marion.sills@ucdenver.edu).

Disclosure: The authors declare no conflict of interest.

This study was supported by NIH/NCATS Colorado CTSA grant UL1 TR001082. Contents are the authors' sole responsibility and do not necessarily represent official NIH views.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.pec-online.com).

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