Association Between Timing of Albuterol and Care Escalation to the Pediatric Intensive Care Unit Within 24 Hours of Admission for Status Asthmaticus

Abstract

Background:

Children admitted to the general in-patient unit for status asthmaticus may not receive the first albuterol treatment on schedule. We sought to determine if a difference in timing between the scheduled and actual first dose of albuterol is associated with care escalation to the pediatric intensive care unit (PICU).

Methods:

We conducted a single-center case–control study of children 2–18 years admitted from the emergency department to the general in-patient unit for status asthmaticus. Cases were defined as children who required transfer to the PICU within 24 hours of admission. Groups were compared using Fisher’s exact or Mann–Whitney U tests. Firth multivariable logistic regression estimated the adjusted association between dose timing and odds of transfer to the PICU.

Results:

Groups did not differ by demographics, comorbidities, or asthma severity risk factors. The median (IQR) time difference between the scheduled and administered first dose of albuterol was 0 (−14 to 63) min for cases and 16 (−6 to 42) min for controls (P = .43). Fifty percent of cases received delayed treatment compared with 63% of controls (P = .26). The adjusted analyses demonstrated that as the time difference between scheduled and administered albuterol increased by 1 min, odds of care escalation to the PICU remained the same (adjusted odds ratio 1.0, 95% CI: 0.9–1.0, P = .18).

Conclusions:

Receiving first albuterol treatment in the general in-patient unit at a time different than scheduled was not associated with increased odds of transfer to PICU.