Asthma in Paediatric Intensive Care in England Residents: Observational Study

Abstract

Purpose Despite high prevalence of asthma in children in the UK, there are no prior report on asthma admissions in paediatric intensive care units (PICU). Methods PICANet, a UK national PICU database, was queried for asthma as the primary reason for admission, of children resident in England from April 2006 till March 2013. Results There were 2,195 admissions to PICU for a median stay of 1.4 days. 59% were males and 51% aged 0-4 years. The fourth and fifth deprivation quintiles represented 61% (1,329) admissions and 73% (11) of the 15 deaths. Deaths were most frequent in 10-14 years age (n=11, 73%), with no deaths in less than 5 years age. 38% of admissions (828/2193) received invasive ventilation, which was more frequent with increasing deprivation (13% (108/828) in least deprived to 31% (260/828) in most deprived) and decreasing age (0-4-year-olds: 49%, 409/828). Conclusions This first multi-centre PICU study in England found that children from more deprived neighbourhoods represented the majority of asthma admissions, invasive ventilation and deaths in PICU. Children experiencing socioeconomic deprivation could benefit from enhanced asthma support in the community.

The influence of disparities on intensive care outcomes in children with respiratory diseases: a systematic review

“…Mukherjee et al studied the characteristics of children admitted at the PICU for asthma. They found that children from deprived neighborhoods comprised most of the PICU admissions (61%); moreover, these children also had the highest proportion of deaths and received mechanical ventilation most frequently 27 . However, they surprisingly reported an increase in the Pediatric Index of Mortality score (PIM2)-score for children that lived in lesser deprived areas, also after adjusting for age, sex and the year 27 .…”

“…They found that children from deprived neighborhoods comprised most of the PICU admissions (61%); moreover, these children also had the highest proportion of deaths and received mechanical ventilation most frequently 27 . However, they surprisingly reported an increase in the Pediatric Index of Mortality score (PIM2)-score for children that lived in lesser deprived areas, also after adjusting for age, sex and the year 27 . Another study on acute respiratory failure in England and Wales also reported a higher proportion of admitted infants coming from deprived areas 28 .…”

“…In this review we describe the influence of socioeconomic, environmental and ethnic disparities on PICU outcomes in childhood respiratory diseases. Children from families living in poverty or being minorities not only comprise a higher proportion of PICU admissions for respiratory diseases 27,28 , but there is an association with higher mortality rates as well 29 . A few possible proposed explanations for the higher prevalence of respiratory diseases and the higher proportion of deaths in this group are psychosocial processes, such as parental stress, overcrowding, illiteracy and malnutrition 27,29 .…”

“…Children from families living in poverty or being minorities not only comprise a higher proportion of PICU admissions for respiratory diseases 27,28 , but there is an association with higher mortality rates as well 29 . A few possible proposed explanations for the higher prevalence of respiratory diseases and the higher proportion of deaths in this group are psychosocial processes, such as parental stress, overcrowding, illiteracy and malnutrition 27,29 . Socioeconomic inequalities tend to have an effect on the morbidity at the PICU as well: children from deprived neighborhoods have a higher severity of illness, a larger chance on respiratory failure and were mechanically ventilated more frequently 16,27,30 .…”

External validation of the Predicting Asthma Risk in Children tool in a clinical cohort

“…Symptoms such as cough and wheeze in preschool‐aged children can be an early sign of asthma and cause a high burden of morbidity and health‐care utilization 1–4 . Asthma also remains an important cause of morbidity later in childhood 5,6 . To reduce childhood asthma morbidity and overtreatment, it is important for clinicians to identify children with asthma early.…”