(671) Factors Associated With Recurrent Asthma Exacerbation Following Pediatric ICU Admission

Introduction: Approximately 5% of pediatric intensive care unit (PICU) admissions are for asthma. Children living in low opportunity neighborhoods have higher odds of multiple PICU admissions. The primary aim of this study was to determine whether children with self-reported uncontrolled asthma in the 4 weeks prior to PICU admission had a higher odds of asthma exacerbation in the year after PICU admission and poorer emotional health.

Methods: Children aged 6 to 17 years old who were admitted to a university-affiliated PICU for asthma were enrolled between 7/2019 and 2/2023. Residential addresses were geocoded and joined by census tract to the Georgia 2015 Childhood Opportunity Index 2.0 scores. Patient Reported Outcome Measure Information Systems (PROMIS) scores were measured using parent and patient assessment. Groups were compared based on the Asthma Control Test (ACT), where a score > 19 indicates controlled asthma in the 4 weeks prior to admission. The primary outcome was asthma exacerbation within the year following admission. Multivariable logistic regression was used to model the odds of recurrent asthma exacerbation in the year after index PICU admission.

Results: Of the 105 children enrolled, 94 children had a geocodable address, and 90 completed all PROMIS measures. Sixty-six (70%) and 28 (30%) children had uncontrolled and controlled asthma, respectively. Twenty-nine (31%) children met the primary outcome; twenty-five (38%) had uncontrolled and 4 (14%) had controlled asthma (p = 0.02). Children with uncontrolled asthma had 3.53 (1.18-13.1) greater odds of a subsequent asthma attack compared to those with controlled asthma. After adjusting for age and living in a COI 2.0 < 40% neighborhood, children with uncontrolled versus controlled asthma had 3.58 (1.17-13.6) higher odds of a subsequent asthma attack. Children with uncontrolled versus controlled asthma had worse PROMIS scores for asthma impact (p < 0.001), life satisfaction (p = 0.02), positive affect (p = 0.02), and psychological stress (p = 0.003).

Conclusions: Use of a standardized, validated asthma control questionnaire at the time of PICU admission may help identify children with worse patient-reported emotional health outcomes who are at risk for recurrent asthma exacerbations even after controlling for age and neighborhood opportunity.