Retrospective review of 200 children hospitalised with acute asthma. Identification of intervention points: A single centre study

Authors

  • Blake F Giarola,

    Corresponding author
    1. Northern Territory Flinders Medical School, Darwin, Northern Territory, Australia
    • Correspondence: Dr Blake F Giarola, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia. Fax: 08 8222 5939; email: blakegiarola@gmail.com

    Search for more papers by this author
  • Gabrielle B McCallum,

    1. Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
    Search for more papers by this author
  • Emily J Bailey,

    1. Queensland Children's Respiratory Centre, Queensland Children's Medical Research Institute, Royal Children's Hospital, Brisbane, Queensland, Australia
    Search for more papers by this author
  • Peter S Morris,

    1. Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
    2. Royal Darwin Hospital, Darwin, Northern Territory, Australia
    Search for more papers by this author
  • Carolyn Maclennan,

    1. Royal Darwin Hospital, Darwin, Northern Territory, Australia
    Search for more papers by this author
  • Anne B Chang

    1. Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
    2. Queensland Children's Respiratory Centre, Queensland Children's Medical Research Institute, Royal Children's Hospital, Brisbane, Queensland, Australia
    Search for more papers by this author

  • Conflict of interest: The authors declare they have no financial or competing conflict of interest, no payment was received from any author to produce the manuscript.

Abstract

Aim

Indigenous Australians with asthma have higher morbidity and mortality compared with non-Indigenous Australians. In children hospitalised with acute asthma, we aimed to (i) determine if acute severity, risk factors and management differed between Indigenous and non-Indigenous children; and (ii) identify intervention points to reduce morbidity and mortality of asthma.

Methods

Retrospective review of 200 children hospitalised to Royal Darwin Hospital with asthma. We compared admission characteristics, severity indices, treatment, discharge plans and readmissions in Indigenous and non-Indigenous children.

Results

Median age was 3.6 years (interquartile range 2.2, 6.8). A significantly higher proportion of Indigenous children (95.2%) were exposed to tobacco smoke compared with non-Indigenous children (45.7%). The difference in proportions was −0.41 (95% confidence interval (CI) −0.60, −0.22). Other risk factors, asthma severity (moderate 83.9% vs. 83.3%; severe 16% vs. 16.1%), length of stay (1.9 vs. 1.3 days) and readmission rate (27.4% vs. 27.5%) were similar between Indigenous and non-Indigenous children. Indigenous children were significantly more likely to be followed up in a community clinic (difference in proportions = 0.10, 95% CI 0.1, 0.17) and less likely by a paediatrician. Only 62.5% of all children had an asthma action plan on discharge.

Conclusion

Unlike other common respiratory diseases requiring hospitalisation, biological factors are unlikely major contributors to the known gap in asthma outcomes between Indigenous and non-Indigenous children. Intervention points include better identification, documentation and management of tobacco smoke exposure, delivery of salbutamol and discharge planning (including education and utilisation of asthma action plans).

Ancillary