Association Between Timing of Albuterol and Care Escalation to the Pediatric Intensive Care Unit Within 24 Hours of Admission for Status Asthmaticus.

Background

Children admitted to the general in-patient unit for status asthmaticus may not receive the first albuterol treatment on schedule. We sought to determine if a difference in timing between the scheduled and actual first dose of albuterol is associated with care escalation to the pediatric intensive care unit (PICU).

Methods

We conducted a single-center case-control study of children 2-18 years admitted from the emergency department to the general in-patient unit for status asthmaticus. Cases were defined as children who required transfer to the PICU within 24 hours of admission. Groups were compared using Fisher's exact or Mann-Whitney U tests. Firth multivariable logistic regression estimated the adjusted association between dose timing and odds of transfer to the PICU.

Results

Groups did not differ by demographics, comorbidities, or asthma severity risk factors. The median (IQR) time difference between the scheduled and administered first dose of albuterol was 0 (-14 to 63) min for cases and 16 (-6 to 42) min for controls (P = .43). Fifty percent of cases received delayed treatment compared with 63% of controls (P = .26). The adjusted analyses demonstrated that as the time difference between scheduled and administered albuterol increased by 1 min, odds of care escalation to the PICU remained the same (adjusted odds ratio 1.0, 95% CI: 0.9-1.0, P = .18).

Conclusions

Receiving first albuterol treatment in the general in-patient unit at a time different than scheduled was not associated with increased odds of transfer to PICU.