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Background: Asthma mortality rates are overall lower in children, but studies estimate 5-10% of asthmatics have refractory mortality prone asthma. Asthmatics with repeat pediatric intensive care unit (PICU) admissions are believed to be at high mortality risk with increased health care utilization and socio-economic challenges.

Objectives/Goal: We aim to identify patients with repeat PICU admissions for status asthmaticus and characterize the levels of interventions and socio-economic status.

Methods: A retrospective chart review was done on patients with the following inclusion criteria: age 0-18, PICU admission between January 2010 to December 2015, and a diagnosis of status asthmaticus on admission. Data was extrapolated from initial ICU admission at any given year, and all subsequent admissions, at least 36 months from date of initial admission. Highest level of respiratory intervention, length of stay, gender, race, insurance, and risk factors (e.g. environment, resource availability, adherence, adverse childhood events) were reviewed.

Results: 440 patients were admitted for asthma to the PICU between 2010-2017. Of those 440, 48 (11%) were readmitted between 2010-2017 for a total of 114 hospitalizations. Interventions for each admission were: 72 (63%) continuous albuterol, 3 (2%) HFNC, 25 (22%) CPAP/BIPAP, 14 (12%) mechanical ventilation/intubation and 0% ECMO. The average stay was ~32 hours (range: 20 min to 204 hours). The ratio of female to male was equal (24:24, 50%). 32 (67%) were Black, 12 (25%) were White, 1 was American Indian and 3 were Other. Most had Medicaid insurance (36, 75%). 32 patients had at least 1 risk factor; 22 had >1 risk factors; 16 patients had none identified. 7 (15%) identified transportation limitation, 6 (13%) had lack of insurance. 19% reported environmental tobacco smoke. ACEs were reviewed; 14 (30%) reported one or more ACE (medical neglect, physical abuse, lack of family support, intimate partner violence, mental health); 12 (25%) had Children’s Division involvement.

Conclusion: Children with repeat admissions to the PICU require higher levels of respiratory interventions. Within this group, 2/3 had resource limitations and medical/clinical nonadherence while 1/3 had intrinsic factors that may have contributed to repeat admissions to PICU. It is significant that 1/3 of these children had experienced at least 1ACE and ¼ had Children’s Division involvement. Therefore, in this cohort, it is imperative to identify underlying risks, including social work involvement and outreach to improve asthma care.

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Socioeconomic factors and PICU interventions in high mortality risk asthmatics