Pediatric Asthma Hospitalizations with Direct Hospital Admission Compared to Admission through an Emergency Department, Texas 2012

BACKGROUND: Asthma hospitalization indicates uncontrolled disease management and is more likely among young, black children in Texas. National studies report differences in patient and hospital characteristics and patient outcomes for children admitted directly compared to through an emergency department (ED). This analysis seeks to compare Texas pediatric asthma patient and hospital characteristics and patient outcomes with direct hospital admission to those with admission through an ED.

METHODS: Texas Health Care Information Collection Inpatient Public Use Data was used to identify asthma hospitalizations (ICD-9 493.XX) among children age 1 to 17 during 2012. Patient records with complete data on sex, race/ethnicity, payer, admission quarter, and hospital name were included for analyses. Patients were excluded if transferred to the hospital or admission source was unknown. Hospital admissions via ED were defined by records with revenue codes 0450, 0451, 0452, 0456, or 0459; all others were direct hospital admissions. High turnover stays were patients with a length of stay less than two nights. Chi-square and Wilcoxon rank sum tests were used to test for statistical significance between direct admissions and admissions via ED for patient and hospital characteristics and outcomes using SAS 9.3.

RESULTS: A total of 8,297 hospitalizations from 192 hospitals met eligibility criteria, including 1,653 (19.9%) admitted for asthma directly to a hospital and 6,644 (80.1%) admitted through an ED. Most hospitalizations were among males (direct and ED admission, 63.0%) and children age 1 to 9 (direct admission, 78.4%; ED admission, 80.9%). Children admitted directly were more likely than children admitted through an ED to be white (32.0% vs. 24.7%) or Hispanic (49.1% vs. 30.8%) (p<.0001), be admitted from January through March (35.8% vs. 27.8%, p<.0001), have a minor illness severity level (73.7% vs. 65.8%), and be admitted in a rural county (13.3% vs. 5.2%). Patients admitted directly were less likely than those admitted through the ED to have public insurance (43.1% vs. 56.0%) or be uninsured (2.5% vs. 5.5%) (p<.0001), be admitted to a children’s hospital (9.7% vs. 46.7%, p<.0001), be a high turnover stay (25.4% vs. 32.9%, p<.0001), and have a hospital charge with a lower mean ($13,616 vs. $20,074, p<.0001) and median ($9,676 vs. $13,762, p<.0001).

CONCLUSIONS: Patient and hospital characteristics varied by whether children with asthma were admitted directly to a hospital or through an ED. Patient outcomes, specifically high turnover stays and hospital charges, were lower among children admitted directly to a hospital than among children admitted through an ED.