Factors associated with length of stay for pediatric asthma hospitalizations

Objective: Asthma is a leading cause of pediatric hospitalizations, but little is known about factors associated with length of stay (LOS) for asthma hospitalizations. The aim of this study was to identify factors associated with LOS for pediatric asthma hospitalizations. Methods: The Pediatric Health Information System (PHIS) was used to cohort patients 2-17 years old with a primary asthma diagnosis discharged from 42 PHIS hospitals in 2011. Sociodemographic, temporal and health-status factors were examined. Bivariate and generalized-estimating-equation logistic regression analyses were performed to identify factors associated with LOS, after adjusting for severity of illness (SOI). Results: In total, 25900 children were hospitalized, with a mean LOS of 1.9 days. In bivariate analysis, mean LOS was longer (p<0.01) for patients with complex chronic conditions (CCC) (3.1 days versus 1.8 for non-CCC) and adolescents (2.3 versus 1.8 for 2-5 years old). In multivariable analysis, obstructive sleep apnea (OSA; OR 2.3; 95% CI: 1.8-2.9), older age (OR 1.3; 95% CI: 1.2-1.4), obesity (OR 1.3; 95% CI: 1.1-1.4), CCC (OR 1.3; 95% CI: 1.1-1.4), winter admissions (OR 1.2; 95% CI: 1.1-1.4), female gender (OR 1.1; 95% CI: 1.1-1.3), and weekend admissions (OR 1.1; 95% CI: 1.03-1.2) had higher odds of asthma LOS >2 days. Conclusions: OSA, older age, obesity, CCC, winter and weekend admissions, and female gender are associated with longer LOS for pediatric asthma hospitalizations, after adjustment for SOI. The study findings suggest that interventions focused on these at-risk groups may prove most useful in reducing LOS for pediatric asthma hospitalizations.