Increased Length of Hospitalization Associated with Infiltration on Chest Radiography in Pediatric Asthma Patients

Purpose: Childhood asthma is common reason for the hospitalization and the deterioration of asthma accompanied with respiratory infection. The burden of treatment asthma is high around the globe also in Asia and the assessment of asthma exacerbation in children is difficult and limited. We aimed to investigate the factors associated to hospitalization period in those were inpatients of pediatric asthma.

Methods: We conducted the chart review of subjects admitted with asthma exacerbation from 2009 to 2014, retrospectively. The subjects consisted of the patients at the age under 18 years visit a single tertiary Hospital. We investigated the characteristics of those patients including clinical symptom and laboratory tests (serum total immunoglobulin (Ig) E, eosinophil counts). We assess the severity of asthma by Pulmonary Score (PS). We assessed the duration of hospitalization to related factors by using bivariate correlation analysis and multiple linear regression analysis using SPSS 20.

Results: A total of 357 subjects with 232 (65.3%) boys and the median age was 5.77 ± 6.1 years old. The mean of hospitalization period were 4.0 ± 1.9 days. The rate of total IgE over than 45 IU/mL was 66.9% and eosinophil count over than 470 /μL was 26.6%. The mean PS was 3.5 ± 1.1 days. The infiltration of chest radiography were 74 cases (20.7%) and body temperature over 38.3 °C were 91(25.5%). The duration of hospitalization was correlated with age (p=0.036, r=0.11). In simple linear regression, PS score positively related with the duration of hospitalization but was not significant (β=0.127, R²=0.037, p=0.16). In multiple linear regression model, the duration of hospitalization was positively related the infiltration finding of chest radiography (β=0.962, p=0.008) and age (β=0.082, p=0.03) with R²=0.052, independent of fever, c-reactive protein, PS, past history of allergy, family history of allergy, elevated IgE and eosinophil count, multiple allergen sensitization and past history of visiting or admitt from asthma exacerbation.

Conclusions: Hospitalization period in pediatric asthma patients has positively correlated with the infiltration finding of chest radiography and no association with PS, total IgE and eosinophil counts. It could be implied that the prediction of morbidity of asthma exacerbation in children has to include the findings on chest radiography that presents respiratory infection. Also, new asthma severity score system for hospitalization of pediatric asthma patients would be needed