Predictors for critical care admission among children presenting to emergency department with recurrent wheezing

Abstract

Context: Children with recurrent wheezing contribute to a significant burden of inpatient hospital admission in developing countries. However, many patients could be managed at home following a short observation period in emergency unit. Aim: This study aimed to determine the predictors of critical care admission in a population of children aged 6 months to 2 years attending pediatric emergency department (ED) for recurrent wheezing. Setting and Design: This is a case-control study conducted in pediatric ED of a tertiary care center in North India. Patients and Methods: Demographic and clinical details were recorded for children aged 6 months to 2 years who presented to ED for "recurrent wheezing" within 48 h of onset of symptoms. Those who were admitted to critical care unit were considered cases and those who were discharged within 6 h of stay at short observation units of ED were considered controls. Statistical Analysis: Logistic regression model was used to determine which of the various demographic and clinical factors best predicted the need for critical care admission. Results: The cases (n = 58) had significantly higher number of emergency visits in the preceding 1 month (P = 0. 018), had more episodes of wheezing in the last 3 months (P = 0.025), had higher respiratory rate (P < 0.001), and had higher clinical severity score (P < 0.001) when compared to control (n = 58) group. Logistic regression model revealed incomplete immunization status of children (P = 0.005) to be a significant risk factor that determine the need for critical care admission. Conclusion: The present cross-sectional study with limited sample size revealed incomplete immunization status of children to be a significant risk factor that determined the need for critical care admission among children below 2 years of age presenting to ED with recurrent wheezing.