ABSTRACT
Objective: To describe potential regional variations in therapies for severe asthma exacerbations in Chilean children and estimate the associated health expenditures. Methods: Observational prospective cohort study in 14 hospitals over a one-year period. Children five years of age or older were eligible for inclusion. Days with oxygen supply and pharmacological treatments received were recorded from the clinical chart. A basic asthma hospitalization basket was defined in order to estimate the average hospitalization cost for a single patient. Six months after discharge, new visits to the Emergency Room (ER), use of systemic corticosteroids and adherence to the controller treatment were evaluated. Results: 396 patients were enrolled. Patients from the public health system and from the north zone received significantly more days of oxygen, systemic corticosteroids and antibiotics. Great heterogeneity in antibiotic use among the participating hospitals was found, from 0 to 92.3% (ICC 0.34, 95% CI 0.16-0.52). The use of aminophylline, magnesium sulfate and ketamine varied from 0 to 36.4% between the different Pediatric Intensive Care Units (ICC 0.353, 95% CI 0.010-0.608). The average cost per inpatient was of $1910 USD. 290 patients (73.2%) completed the follow-up six months after discharge. 76 patients (26.2%) were not receiving any controller treatment and nearly a fourth had new ER visits and use of systemic corticosteroids due to new asthma exacerbations. Conclusions: Considerable practice variation in asthma exacerbations treatment was found among the participating hospitals, highlighting the poor outcome of many patients after hospital discharge, with an important health cost
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Subject(s)
Humans , Male , Female , Child , Asthma/epidemiology , Adrenal Cortex Hormones/therapeutic use , Cost of Illness , Asthma/economics , Chile/epidemiology , Cohort Studies , Disease Progression , Emergency Medical Services , Follow-Up Studies , Hospitalization , Prospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: Asthma hospitalization rates in Chilean children have increased in the last 14 years, but little is known about the factors associated with this. OBJECTIVE: Describe clinical characteristics of children hospitalized for asthma exacerbation. METHODS: Observational prospective cohort study in 14 hospitals. Over a one-year period, children five years of age or older hospitalized with asthma exacerbation were eligible for inclusion. Parents completed an online questionnaire with questions on demographic information, about asthma, indoor environmental contaminant exposure, comorbidities and beliefs about disease and treatment. Disease control was assessed by the Asthma Control Test. Inhalation technique was observed using a checklist. RESULTS: 396 patients were enrolled. 168 children did not have an established diagnosis of asthma. Only 188 used at least one controller treatment at the time of hospitalization. 208 parents said they believed their child had asthma only when they had an exacerbation and 97 correctly identified inhaled corticosteroids as anti-inflammatory treatment. 342 patients used the wrong spacer and 73 correctly performed all steps of the checklist. CONCLUSIONS: Almost half of the patients were not diagnosed with asthma at the time of hospitalization despite having a medical history suggestive of the disease. In the remaining patients with an established diagnosis of asthma potentially modifiable factors like bad adherence to treatment and poor inhalation technique were found. Implementing a nationwide asthma program including continued medical education for the correct diagnosis and follow up of these patients and asthma education for patients and caregivers is needed to reduce asthma hospitalization rates in Chilean children
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Subject(s)
Humans , Asthma/epidemiology , Hospitalization/statistics & numerical data , Patient Education as Topic , Observational Study , Adrenal Cortex Hormones/therapeutic use , Asthma/therapy , Caregivers , Disease Progression , Education, Medical, Continuing , Prospective Studies , Patient ComplianceABSTRACT
El asma bronquial es la enfermedad crónica más frecuente en la infancia. Todos los años un número importante de pacientes pediátricos se hospitaliza por esta causa. No existe en Chile un conocimiento sobre su magnitud. Objetivo: Conocer la tasa de hospitalización por asma en niños de 5 a 15 años y evaluar su evolución en el tiempo. Pacientes y Método: Se calculó la tasa de hospitalización por asma en base al número de egresos hospitalarios del registro de egresos del Departamento de Estadística e Información de Salud del Ministerio de Salud de Chile (DEIS) y de las poblaciones expuestas al riesgo de hospitalización obtenidas de las proyecciones de población, proporcionadas por el Instituto Nacional de Estadística. Se evaluó la evolución de estas tasas desde el año 2001 al 2014. Resultados: Durante el lapso estudiado se observó un aumento significativo de la tasa de hospitalización por asma en niños, desde 3,8 por 10.000 habitantes el 2001 a 7,8 por 10.000 habitantes el 2014. El promedio de edad fue de 8,5 ± 2,7 años, siendo de sexo masculino el 57,58% de los pacientes con una mediana de estadía hospitalaria de 3 días (rango 1-12). Conclusiones: La tasa actual de hospitalizaciones por asma en Chile en niños de 5 a 15 años es de 7,8 por 10.000 habitantes, observándose una duplicación de ésta en los 14 años estudiados.
Bronchial asthma is the most prevalent chronic disease in children. Every year an important number of asthmatic children is hospitalized for asthma crisis. The magnitude of this problem in Chile is unknown. Objective: To evaluated the asthma hospitalization rate in 5-15 year-old children and evaluate their evolution. Patients and Method: We calculate the asthma hospitalization rate in children based on data from the National Hospitalization Discharge Registry from the Statistics and Health Information Department of the Ministry of Health (DEIS) and the National Institute of Statistics (INE). We evaluate the evolution of these rates from 2001 to 2014. Results: We observed a significant increase in the asthma hospitalization rates in children from 3,8 for 10.000 inhabitants in 2001 to 7,8 for 10.000 inhabitants in 2014. The average age was 8,5 years ± 2,7. Male gender was predominant (57,58%) with a mean length of stay of 3 days (range 1-12). Conclusions: The actual asthma hospitalization rate in Chile is 7,8 for 10.000 inhabitants for children 5 to 15 years old, with a double increase in this rate during the 14 year period analyzed.
