Risk factors for emergency department visit in a prospective open cohort of asthmatic children

Abstract BackgroundRisk factors of emergency department (ED) visits have mainly been obtained from hospital cohorts.ObjectiveTo evaluate risk factors for ED visits in asthmatic children in an out-of-hospital cohort.MethodsWe led a prospective study in an open cohort of 933 asthmatic children followed-up by a specialized pediatrician. We measured the annualized rate of ED visits since age two and described their characteristics at last visit.ResultsMean age (± SD) at last visit was 11.1 ± 3.3 years, and the annualized rate of ED visit was 0.194 ± 0.356. Two groups were defined: one with no ED visits (n = 463), and the other with at least one ED visit (n = 470). The latter group included younger children, with multiple sensitizations and more frequent early atopic dermatitis, who reported having more inhaled corticosteroid (ICS) treatment and a more severe exacerbation rate in the three months prior to the last visit. Socioeconomic status did not influence the rate of ED visits. In a logistic regression, the absence of hospitalization before 2 years of age and of atopic dermatitis had odds ratios of 0.38 (95% confidence interval: 0.23–0.65) and of 0.57 (95% confidence interval: 0.42–0.79) respectively to predict at least one ED visit. When an asthmatic child had no early hospitalization and no atopic dermatitis, the relative risk of ED visit was decreased by 28%.ConclusionAsthmatic children with an absence of atopic dermatitis and hospitalization before two years of age are less prone to emergency department visit after age two.