RESUMO
OBJECTIVE: Single-center studies have reported varying relapse rates after treatment of patients with acute asthma. We determined the relapse rate after emergency department (ED) treatment in a cohort of children. DESIGN: This was a prospective inception cohort study performed during 1997-1998. SETTING: The study was performed in 44 EDs including both general and pediatric centers. PATIENTS: Children (n = 1184) aged 2 to 17 years who had been admitted to EDs, with acute asthma restricted to 881 patients discharged from the ED. MAIN RESULTS: Two weeks after discharge, families were telephoned to determine relapse. Follow-up data were available for 762 (86%) of the children with a 10% incidence of relapse. On univariate analysis several factors were associated with relapse including current medications and markers of asthma severity. On multivariate analysis the factors associated with relapse were age (OR 1.4 per 5-year increase), use of second-line asthma medications (OR 3.7), exposure to cigarette smoke (OR 0.5), and ED visits within the past year (OR 1.2 per 5 ED visits). CONCLUSIONS: The incidence of relapse among children is lower than that observed among adults and varies with age. Other risk factors such as frequent ED visits are likely markers of chronic asthma severity. Further research should focus on ways to decrease the relapse rate among patients at high risk.
Assuntos
Asma/prevenção & controle , Asma/epidemiologia , Canadá/epidemiologia , Criança , Doença Crônica , Emergências , Feminino , Humanos , Masculino , Análise Multivariada , Razão de Chances , Estudos Prospectivos , Risco , Prevenção Secundária , Estatísticas não Paramétricas , Estados Unidos/epidemiologiaRESUMO
One hundred and seventy-five infants less than 8 weeks of age, presenting to the pediatric emergency room of the Bronx Municipal Hospital Center with rectal temperature greater than or equal to 38 degrees C (100.4 degrees F), were studied. House officers recorded their impressions of the infants on a number of variables prior to performing a lumbar puncture and obtaining laboratory data. All infants were admitted for parenteral antibiotic therapy pending culture results. Culture-positive bacterial infections occurred in 6.3% (n = 11); the incidence of bacteremia was 3.4% (n = 6). Of special concern were the 134 infants who had no visible source for their fever during the first examination. A major goal was to determine whether there were any early predictors of bacteremia in this group. The individual variables of white blood cell count greater than or equal to 15,000/mm3, band count greater than or equal to 500/mm3, temperature, impression of irritability, tone, cry, and activity level were not related to the presence of bacteremia. An erythrocyte sedimentation rate greater than or equal to 30 and the examiner's impression of sepsis were significantly associated with bacteremia but did not correctly identify all cases. However, the combination of impression of sepsis, white blood count greater than or equal to 15,000/mm3, and erythrocyte sedimentation rate greater than or equal to 30 identified all infants with bacteremia and excluded 82% of the infants who were eventually shown not to have bacteremia.