Abstract
Background and objectives: Asthma is one of the most important reasons of hospitalization in children, which together with infections cause the 50% of admissions to hospital in children with 1 to 4 years of age and 33% who are 5 to 9 years old. Although deaths due to asthma usually happen out of the hospital, but high risk children may be identified upon their previous medical history before admission to PICU. Patients who do not respond considerably to primary treatments in emergency department must be transferred to PICU for close observation, monitoring and further treatment. Hypoxia, dehydration, acidosis and hypokalemia make these patients susceptible to cardiac Dysrhythmia and cardio respiratory arrest.
Mortality rate due to asthma is increasing predominantly because of under diagnosis, delayed referral and inappropriate treatment. According to burden of asthma and its fatality if not be classified or treated properly, the early recognition of high-risk asthmatic children who must be admitted to PICU and to avoid unnecessary admissions, play a significant role in management of asthma, therefore we planned this study to identify predictive factors of PICU admission for asthmatic children.
Materials and Methods: This comparative (analytical) and cross-sectional study on 70 asthmatic children (40 patients admitted to ward and 30 patients to PICU) carried out to determine epidemiologic and clinical factors, laboratory and radiologic findings and treatments in two groups of patients, who admitted to PICU versus respiratory ward. Statistical tests including T-test and Chi-square were used to analyze and compare results between these groups.
Results: This study showed no meaningful difference in epidemiologic and radiologic findings, but revealed some statistically significant difference in presenting clinical signs such as: Cyanosis (P=0.002), Tachypnea (P=0.04) and Tachycardia (P=0.01) between two groups of patients, who admitted to PICU versus respiratory ward. Besides, there were some meaningful differences in their laboratory findings, including lower PaO2 (P=0.03) and higher PaCO2 (P=0.04) in patients admitted to PICU than who admitted to ward. Previous positive history of PICU admission and/or inappropriate medical treatment was more common in PICU admitted patients than ward admitted group.
Conclusion: Results tto this study showed that cyanosis, rapid respiratory and pulse rates, low PaO2 , high PaCO2 , previous positive history of PICU admission and inappropriate medical treatment, all prepare an asthmatic patient to need PICU readmission. The guidelines for PICU admission of asthmatic patients can be formed using the findings of this study.