D2.141 - Predictors of inpatient admission amongst children presenting with acute asthma exacerbation: influence of the patient’s prior clinical profile

The Short Stay Unit (SSU) represents an intermediate management strategy for patients with acute asthma exacerbation who do not meet immediate criteria for discharge from the emergency service nor for direct admission to the Paediatric Ward (PW). Although most patients show a favourable clinical course during SSU stay, a relevant proportion subsequently requires admission to the ward. This study aimed to identify aspects of the patient’s prior clinical profile associated with failure of SSU management and subsequent PW admission.

An observational retrospective case-control study was conducted including paediatric patients with a primary diagnosis of acute asthma exacerbation between 2021 and 2025. Cases were defined as patients who, after admission to the SSU, required subsequent admission to the PW. Controls were patients who were discharged directly from SSU. Demographic and clinical data were collected from medical records, including age, sex, previous hospitalisations for asthma, use of maintenance therapy, family history of atopy, and personal history of other atopic conditions. No matching between cases and controls was performed; instead, potential confounders were addressed through multivariable logistic regression analysis to identify factors independently associated with PW admission. The model’s discriminative performance was evaluated using ROC curve analysis.

A total of 202 patients were included, of whom 51 (25.2%) required admission to the PW. The baseline demographic and clinical characteristics of the study population are presented in Table 1. In the multivariable model, factors independently associated with the need for PW admission were previous hospitalisations for asthma (OR 6.68; 95% CI 3.02–14.78), family history of atopy (OR 2.31; 95% CI 1.11–4.80) and personal history of other atopic conditions (OR 2.65; 95% CI 1.22–5.74). Age, sex and use of maintenance therapy were not significantly associated with the outcome. The model showed good discriminative performance (AUC 0.79).

Inpatient admission amongst children presenting with acute asthma exacerbation was associated with previous hospitalisations for asthma exacerbations and with personal and family atopic background. Identification of these factors may support improved risk stratification of patients more likely to experience inpatient admission, allowing more informed decisions regarding patient treatment and allocation.