Regional variation in ICU care for pediatric patients with asthma

Susan L. Bratton, Folafoluwa O. Odetola, Jamie McCollegan, Michael D. Cabana, Fiona H. Levy, Heather T. Keenan

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

Objective: To determine adherence to guidelines for severe asthma care and evaluate regional variability in practice among pediatric intensive care units (PICU). Study design: A retrospective cohort study of children treated for asthma in a PICU during 2000 to 2003. We utilized the Pediatric Health Information System (PHIS) database to identify patients and determine use of asthma therapies when patients did not improve with standard therapy (inhaled β-agonists and systemic corticosteroids). Results: Of 7125 children studied, 59% received inhaled anticholinergic medications. Use of other therapies included systemic β-agonists (n = 1841 [26%]), magnesium sulfate (n = 1521 [21%]), methylxanthines (n = 426 [6%]), inhaled helium-oxigen gas mixture (heliox) (n = 740 [10%]), and endotracheal intubation with ventilation (n = 1024 [14%]). Use of therapies varied by census region. Over half the patients (n = 524) who received ventilation did so for ≤1 day. Adjusted for severity of illness, use of mechanical ventilation varied significantly by census division; however, much of the variation was among children ventilated for ≤1 day. Conclusion: Adherence to national guidelines for use of inhaled anticholinergics among critically ill children is low, and marked variation in use of invasive ventilation exists. More explicit guidelines regarding indications for invasive ventilation may improve asthma care.

Original languageEnglish (US)
Pages (from-to)355-361
Number of pages7
JournalJournal of Pediatrics
Volume147
Issue number3
DOIs
StatePublished - Sep 1 2005
Externally publishedYes

Fingerprint

Ventilation
Patient Care
Asthma
Pediatrics
Pediatric Intensive Care Units
Cholinergic Antagonists
Censuses
Guidelines
Health Information Systems
Guideline Adherence
Magnesium Sulfate
Helium
Intratracheal Intubation
Therapeutics
Artificial Respiration
Critical Illness
Adrenal Cortex Hormones
Cohort Studies
Retrospective Studies
Gases

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Bratton, S. L., Odetola, F. O., McCollegan, J., Cabana, M. D., Levy, F. H., & Keenan, H. T. (2005). Regional variation in ICU care for pediatric patients with asthma. Journal of Pediatrics, 147(3), 355-361. https://doi.org/10.1016/j.jpeds.2005.05.008

Regional variation in ICU care for pediatric patients with asthma. / Bratton, Susan L.; Odetola, Folafoluwa O.; McCollegan, Jamie; Cabana, Michael D.; Levy, Fiona H.; Keenan, Heather T.

In: Journal of Pediatrics, Vol. 147, No. 3, 01.09.2005, p. 355-361.

Research output: Contribution to journalArticle

Bratton, SL, Odetola, FO, McCollegan, J, Cabana, MD, Levy, FH & Keenan, HT 2005, 'Regional variation in ICU care for pediatric patients with asthma', Journal of Pediatrics, vol. 147, no. 3, pp. 355-361. https://doi.org/10.1016/j.jpeds.2005.05.008
Bratton, Susan L. ; Odetola, Folafoluwa O. ; McCollegan, Jamie ; Cabana, Michael D. ; Levy, Fiona H. ; Keenan, Heather T. / Regional variation in ICU care for pediatric patients with asthma. In: Journal of Pediatrics. 2005 ; Vol. 147, No. 3. pp. 355-361.
@article{b9f4fbda69584654be311d69dc20c53e,
title = "Regional variation in ICU care for pediatric patients with asthma",
abstract = "Objective: To determine adherence to guidelines for severe asthma care and evaluate regional variability in practice among pediatric intensive care units (PICU). Study design: A retrospective cohort study of children treated for asthma in a PICU during 2000 to 2003. We utilized the Pediatric Health Information System (PHIS) database to identify patients and determine use of asthma therapies when patients did not improve with standard therapy (inhaled β-agonists and systemic corticosteroids). Results: Of 7125 children studied, 59{\%} received inhaled anticholinergic medications. Use of other therapies included systemic β-agonists (n = 1841 [26{\%}]), magnesium sulfate (n = 1521 [21{\%}]), methylxanthines (n = 426 [6{\%}]), inhaled helium-oxigen gas mixture (heliox) (n = 740 [10{\%}]), and endotracheal intubation with ventilation (n = 1024 [14{\%}]). Use of therapies varied by census region. Over half the patients (n = 524) who received ventilation did so for ≤1 day. Adjusted for severity of illness, use of mechanical ventilation varied significantly by census division; however, much of the variation was among children ventilated for ≤1 day. Conclusion: Adherence to national guidelines for use of inhaled anticholinergics among critically ill children is low, and marked variation in use of invasive ventilation exists. More explicit guidelines regarding indications for invasive ventilation may improve asthma care.",
author = "Bratton, {Susan L.} and Odetola, {Folafoluwa O.} and Jamie McCollegan and Cabana, {Michael D.} and Levy, {Fiona H.} and Keenan, {Heather T.}",
year = "2005",
month = "9",
day = "1",
doi = "10.1016/j.jpeds.2005.05.008",
language = "English (US)",
volume = "147",
pages = "355--361",
journal = "Journal of Pediatrics",
issn = "0022-3476",
publisher = "Mosby Inc.",
number = "3",

}

TY - JOUR

T1 - Regional variation in ICU care for pediatric patients with asthma

AU - Bratton, Susan L.

AU - Odetola, Folafoluwa O.

AU - McCollegan, Jamie

AU - Cabana, Michael D.

AU - Levy, Fiona H.

AU - Keenan, Heather T.

PY - 2005/9/1

Y1 - 2005/9/1

N2 - Objective: To determine adherence to guidelines for severe asthma care and evaluate regional variability in practice among pediatric intensive care units (PICU). Study design: A retrospective cohort study of children treated for asthma in a PICU during 2000 to 2003. We utilized the Pediatric Health Information System (PHIS) database to identify patients and determine use of asthma therapies when patients did not improve with standard therapy (inhaled β-agonists and systemic corticosteroids). Results: Of 7125 children studied, 59% received inhaled anticholinergic medications. Use of other therapies included systemic β-agonists (n = 1841 [26%]), magnesium sulfate (n = 1521 [21%]), methylxanthines (n = 426 [6%]), inhaled helium-oxigen gas mixture (heliox) (n = 740 [10%]), and endotracheal intubation with ventilation (n = 1024 [14%]). Use of therapies varied by census region. Over half the patients (n = 524) who received ventilation did so for ≤1 day. Adjusted for severity of illness, use of mechanical ventilation varied significantly by census division; however, much of the variation was among children ventilated for ≤1 day. Conclusion: Adherence to national guidelines for use of inhaled anticholinergics among critically ill children is low, and marked variation in use of invasive ventilation exists. More explicit guidelines regarding indications for invasive ventilation may improve asthma care.

AB - Objective: To determine adherence to guidelines for severe asthma care and evaluate regional variability in practice among pediatric intensive care units (PICU). Study design: A retrospective cohort study of children treated for asthma in a PICU during 2000 to 2003. We utilized the Pediatric Health Information System (PHIS) database to identify patients and determine use of asthma therapies when patients did not improve with standard therapy (inhaled β-agonists and systemic corticosteroids). Results: Of 7125 children studied, 59% received inhaled anticholinergic medications. Use of other therapies included systemic β-agonists (n = 1841 [26%]), magnesium sulfate (n = 1521 [21%]), methylxanthines (n = 426 [6%]), inhaled helium-oxigen gas mixture (heliox) (n = 740 [10%]), and endotracheal intubation with ventilation (n = 1024 [14%]). Use of therapies varied by census region. Over half the patients (n = 524) who received ventilation did so for ≤1 day. Adjusted for severity of illness, use of mechanical ventilation varied significantly by census division; however, much of the variation was among children ventilated for ≤1 day. Conclusion: Adherence to national guidelines for use of inhaled anticholinergics among critically ill children is low, and marked variation in use of invasive ventilation exists. More explicit guidelines regarding indications for invasive ventilation may improve asthma care.

UR - http://www.scopus.com/inward/record.url?scp=25144454655&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=25144454655&partnerID=8YFLogxK

U2 - 10.1016/j.jpeds.2005.05.008

DO - 10.1016/j.jpeds.2005.05.008

M3 - Article

C2 - 16182675

AN - SCOPUS:25144454655

VL - 147

SP - 355

EP - 361

JO - Journal of Pediatrics

JF - Journal of Pediatrics

SN - 0022-3476

IS - 3

ER -