Elsevier

Journal of Pediatric Nursing

Volume 30, Issue 2, March–April 2015, Pages 364-384
Journal of Pediatric Nursing

Risk Factors Associated With Hospital Readmission in Pediatric Asthma

https://doi.org/10.1016/j.pedn.2014.09.005Get rights and content

Highlights

  • Multiple hospital admissions are common in pediatric asthma patients with major family concern and economic burden.

  • Risk factors associated with hospital readmission in pediatric asthma have not been fully elucidated.

  • Various risk factors are reviewed in the categories of demographic, environmental, psychosocial and clinical aspects.

  • African American, public or no insurers, previous admission and complex chronic comorbidity are identified as risk factors

Asthma is a leading cause of hospitalization among children, and about 15–50% of pediatric patients are readmitted after an index admission. The purpose of this integrative review is to explore contemporary scientific findings on the association between pediatric asthma readmission and various demographic, environmental, psychosocial and clinical risk factors. An electronic database search resulted in a sample of 29 studies. African American, public or no insurers, previous admission and complex chronic comorbidity were identified as risk factors associated with pediatric asthma readmission. However, more interdisciplinary and well-designed investigations are warranted to further explicate the spectrum of environmental and psychosocial correlates.

Section snippets

Design

The design of this study primarily followed the guidelines and framework published by the Center for Reviews and Dissemination (2009) for integrative reviews. The primary purpose of this review is to explore the association between pediatric asthma readmission and various risk factors including demographic, environmental, psychosocial and clinical factors. All risk factors discussed in the review represent these five classes.

Search Criteria

The inclusion criteria for target studies were: (a) stated purpose was primarily to examine readmission for pediatric asthma; (b) the target population was children aged 0–18; (c) published in English. Exclusion criteria were: (a) case reports, meta-analyses, or systemic review articles that did not adopt a research design; (b) abstracts, dissertations, manuscripts, or conference proceedings that were not published in peer reviewed journals; (3) theoretical, expert opinion, editorial, or any

Publication Years and Recruited Sample

Twelve out of 29 (41%) of the reviewed articles were published in the past five years (2009–2014). Fifteen of 29 (51.7%) reviewed papers were conducted in USA, and 5 (17%) were from Canada. There were also a portion of studies conducted from France, Nordic Countries, Netherlands, Turkey, Australia, and New Zealand, as well as other non-western countries including Thailand, Saudi Arabia, and Brazil.

The developmental stage of children in selected studies included all pediatric age group from

Demographic Risk Factors

The contradictory results from different studies indicate that age younger than 5 years and adolescents are two important age groups at risk for higher readmission after index discharge. Eight studies (Chen, Dales, et al., 2003, Delmas et al., 2011, Farber, 1998, Kocevar et al., 2004, Lasmar et al., 2006, Li et al., 2012, Mitchell et al., 1994, To et al., 1996, Wever-Hess et al., 2001) found that higher rates of asthma readmission occur in younger compared to older children. However, most

Limitations1

The inclusion and exclusion criteria adopted for this systematic review may pose some limitations to our findings. First, the choice of terms defining risk factor and readmission may have excluded some relevant studies. Secondly, all reviewed articles have no time limitations and includes studies from 1994 to 2014. During this time frame there has been some changes in the beliefs and emphasis in clinical practice related to the environmental impact on asthma diagnosis and treatment. Over the

Conclusions

This review includes a large number of studies that have examined risk factors associated with hospital readmission for pediatric asthma using various research designs. There have been several risk factors associated with increased hospital readmission in pediatric asthma population that have repeatedly emerged in these studies under the categories of demographic, environmental, psychosocial and clinical factors linked with asthma. Although demographic and clinical risk factors have been widely

Acknowledgments

No extramural funding.

No previous presentations.

No commercial financial support.

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