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Abstract
Objective: To evaluate the effect of 24
hours of observation care on hospitalization
in asthmatic children at our Pediatric
Emergency Center (PEC).
Design: Cross-sectional analysis of discharge
data from 1987-1998.
Setting: Hamad General Hospital, State
of Qatar Population Studied: children
(0-14 years) who were hospitalized with
the primary diagnosis of asthma.
Intervention: None Results: There were
4402 discharges during the study period.
Of these 81 % were younger than 5 years,
14% were between 5 and 10 years. Male
accounted for 67% and Qatar nationals
accounted for 66%. There was a sharp decline
in the asthmatic hospitalization rate
from 455 in 1987-89 to 67 per 100,000
children in 1991-98 after the opening
of the 24 hours observation care at PEC.
The average cost per admission was $1,544
compared to $100 per 24hours emergency
observation care.
Conclusions: This marked decline in our
pediatric asthmatic hospitalization rate
in the 90's, reflect the value of 24hours
observation care at the Pediatric Emergency
Center. Therefore, our finding strongly
favors that 24 hours observation care
should be included in the management of
acute asthmatics in the international
guidelines for global asthma initiative.
 Introduction:
Asthma is the most common chronic respiratory
disease that requires frequents hospitalization.
In the past 2 decades, there was an increase
in prevalence, rate of hospitalization
and mortality due to asthma especially
in children and young adults (1-3). This
increasing trend in morbidity and mortality
ha~ been reported in a number of countries
including New Zealand, Great Britain,
France, Italy, United States, and Asia
(4, 5)
Socioeconomic factors such as limited
health care access, psychosocial dysfunction
of patient or family, overuse or inappropriate
use of asthma medication, underestimation
of asthma severity by the patient or the
physician and exposures to environmental
agents either outdoor or indoor have been
implicated as the causes of this increase
(6).
The State of Qatar is not of special interest
because it is a member of the gulf states
and have an abundance of resources but
because of its unique situation of having
only one large hospital which covers the
whole State. To date this is the first
data published to evaluate the trend in
pediatric asthma hospitalizations, and
the impact of the 24 hours observation
care at the pediatric emergency center
on hospitalizations.
Materials and Methods:
Study populations The primary study
population comprised of residents of the
State of Qatar during the period of the
study. Also, we compared this data to
previous populations from USA and Saudi
Arabia ( 1-9).
Data sources
The hospitalization data were obtained
from Health Information Services (HIS)
at Hamad Medical Cooperation (HMC). The
HIS obtains the discharge data from the
medical records at HMC, then collects
them in computerized form for vital statistics.
Hospitalization data for the United States
were obtained from published reports from
the National Hospital Discharge Survey
(8) and Chicago (9).
Analysis
We defined the asthma hospitalization
as any hospital discharge with a primary
diagnosis code of 493 as per the International
Classification of Diseases -Clinical Modification
(ICD-9-CM). Our data was gathered in accordance
with those used by Mannino et al and Thomas
et al.
The population of Qatar is estimated to
be 534,000 of which children less than
14 years of age contribute to about 20%,
giving the pyramidal shape of the developing
countries (10), of which Qatar born (nationals)
residents accounted for 50%.
Results:
There were 4402 asthma hospitalizations
in the State of Qatar during1987 through
1998. Of these 81 % were younger than
5 years, 14% were between 5 and 10 years
and 5% were 10 years or older. The median
age of hospitalized patients was 3.6 years.
Qatar born (nationals) residents account
for 66% of the asthma hospitalizations.
Table 1.
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Category
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No. of Hospitalization
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Percent of Total
Hospitalization (%)
|
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Age, yr
0-4
5-9
10-15
Total
Sex
Female
Male
Nationality
Qatar nationals
non Qatari
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3572
630
200
4402
1446
2956
2925
1477
|
81
14
5
33
67
66
34
|
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Table I -Asthma
Hospitalizations for
the State of Qatar Residents,
1987-98
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There was a sharp decline of asthma hospitalization rate from 455 in 1987 to 67 per 100,000 children in 1998. However there were more Qatar national patients hospitalized
than non-Qatar national residents in all age groups. Figure I
There was a sharp rise in the asthma hospitalizations in , 1988,1989, and 1990 of mostly those younger than 5 years of
age.
The average cost per admission was $1,544, compared to $100 per 24hours observation in the pediatric emergency center.
Discussion:
Asthma is a chronic respiratory illness
with a significant and growing public
health concern for the State of Qatar,
even though our hospitalization rate is
below the USA national Healthy People
2000 objectives (11).
The rapid increase in asthma hospitalizations
especially in those less than 5 years
of age as noted in 1988,1989, and 1990
is still inexplicable and need further
evaluation. The current asthma hospitalization
rate is lower than the hospital admission
rate in the United States (195 and 428
per 100,000 population for USA and Chicago
residents respectively) in 1995 (8,9)
and Saudi Arabia (161 per 100,000 population
of Jeddah) in 1994 (5).
There are several reasons for the low
prevalence of asthma hospitalization in
the State of Qatar. For example, increased
level of education in the population,
increased living standards, easy access
to free health care system, free medications
and opening of the 24hours observation
area.
The decline in asthma hospitalization
by 85% was noted at the time of the opening
of Al-Saad pediatric emergency center
with 24 hours observation area for asthmatic
children in 1991.
The goal of any treatment guideline is
to have a positive effect on the care
and management of the disease, also it
should be practical and include a variety
of different subgroups (12,13). The NIH
Expert Panel Report is built around 4
components of the diagnosis and management
of asthma: assessment and monitoring of
asthma, control of factors contributing
to asthma severity, pharmacologic therapy,
and education.
This study showed a significant effect
of 24 hours observation care in our emergency
center on pediatric asthma hospitalization
with less admission and hence less health
care expenditure as shown in this paper.
In-conclusion, the 24 hours observation
care in the pediatric
emergency center is an important tool
in assessing and monitoring asthma. Therefore,
we recommend that the 24 hours observation
care should be included in the management
of acute asthma in the international guidelines
for global asthma initiative.
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Figure I -The trends
of asthma hospitalization for children
(0-14 years) in the State of Qatar
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References:
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