Predictors of repeat visits to the emergency room by asthmatic children in primary care

ABSTRACT

BACKGROUND: Subsets of asthmatic children, particularly in the Caribbean, burden the health system through repeated emergency room (ER) visits. We examined children to determine predictors of repeated ER visits in Trinidad. Methods: Caregivers of 300 asthmatic children in primary healthcare in Trinidad reported on perceived factors of exacerbated wheeze requiring ER services. RESULTS: Prevalence of ER utilization in the past 12 months was 59.7 per cent and 40.3 per cent for repeated visits. Average age of wheezing onset was 2.8 (SD = 2.5) years. From the logistic regression analyses, independent predictors of repeat ER visits were mothers with a history of asthma (OR = 2.0, 95 per cent Cl = 1.0-4.0), exposure to perfumes/odors (OR = 2.4, 95 per cent Cl = 1.4-4.2), using inhaled corticosteroids (ICS) (OR = 2.2, 95 per cent Cl = 1.2-4.0), and young age group (1-5 vs. 13-16 years) (OR = 2.7, 95 per cent Cl = 1.1-6.4). More 1-5 year-olds (63.8 per cent) and 6-12-year-olds (60.2 per cent) wheezed in the dry and wet seasons, respectively (p = 0.04). Follow-up was poor (32.3 per cent), and disease management did not include educational interventions. CONCLUSIONS: Repeated ER use in pediatric asthma underscores a pressing need for health providers and caregivers to develop an asthma management plan noting the identified predictors to assist in reducing Trinidad's asthma burden.