Assistant Professor Rady Children's Hospital San Diego Rady Children's Hospital San Diego, California, United States
Background: Under-diagnosis of asthma among children has not been described in the emergency department (ED) setting. Understanding the prevalence of asthma under-diagnosis in the ED is important to developing solutions to reduce asthma ED visits.
Objective: To examine the prevalence of asthma under-diagnosis in an ED population and explore associations with sociodemographic and clinical characteristics.
Design/Methods: We surveyed parents of children ages 2–17 years seeking ED care for respiratory symptoms. Data collection included socio-demographics, a validated asthma diagnostic screening survey, prior asthma care and morbidity, and whether the child had been previously diagnosed with asthma by a physician. Under-diagnosed asthma was defined as a positive screening asthma survey response and no prior physician diagnosis of asthma. Using chi-square and t-tests, we compared sociodemographic and clinical factors of those with an asthma diagnosis to those with under-diagnosed asthma. We used multivariable logistic regression models to evaluate the relative contribution of sociodemographic and clinical factors to the likelihood of asthma under-diagnosis.
Results: Of 362 children, 36% were under-diagnosed. Compared to diagnosed children, those under-diagnosed were younger, had parents who were younger and were less likely to exclusively speak English at home (all p<0.05) (Table 1). Asthma-related morbidity was common among under-diagnosed children (Table 2). In fact, among under-diagnosed children, 42% had moderate or severe asthma symptoms, and 66% had experienced ≥ 1 asthma-related exacerbation in the prior 12 months. Parent-reported use of a controller medication was higher among diagnosed versus under-diagnosed children (60% vs. 21%, p=0.01). In the multivariable regression (adjusting for insurance, education, income, and preferred language), older children (OR 0.76, 95% CI [0.69, 0.84]), use of a controller (OR 0.23, 95% CI [0.13, 0.44]), and ≥ 1 asthma exacerbation in the prior year (OR 0.42, 95% CI [0.18, 0.94]) were associated with lower odds of asthma under-diagnosis (all p<0.05). Conclusion(s): Under-diagnosed asthma is common in the ED setting and is associated with substantial parent-reported morbidity, under-treatment and younger children. Appropriate diagnosis and treatment, including the use of guideline-recommended controller medications and appropriate specialist referral, may significantly reduce morbidity and health care costs for these children.
Authors/Institutions: Kathryn H. Pade, Rady Children's Hospital, San Diego, California, United States; Lindsey R. Thompson, University of California, Los Angeles, Los Angeles, California, United States; Bahareh Ravandi, Children's Hospital Los Angeles, Los Angeles, California, United States; Todd Chang, Children's Hospital Los Angeles, Los Angeles, California, United States; Frances Barry, UCLA, Los Angeles, California, United States; Jill Halterman, University of Rochester School of Medicine, Rochester, New York, United States; Peter G. Szilagyi, UCLA School of Medicine, Los Angeles, California, United States; Sande Okelo, UCLA, Los Angeles, California, United States