D2.120 - Missing the Red Flags? Identification of High-Risk Paediatric Asthma Admissions Following the 2024 BTS/NICE/SIGN Update

Asthma remains a major cause of paediatric hospital admission and is associated with preventable morbidity and mortality. Recurrent admissions and repeated courses of oral corticosteroids are recognised risk factors for poor outcomes. The 2024 BTS/NICE/SIGN asthma guidelines emphasise proactive identification of high-risk patients, timely specialist referral, and completion of asthma discharge bundles. This update provides an opportunity to assess current practice against new national standards.

Aim was to evaluate adherence to the 2024 BTS/NICE/SIGN asthma guidelines in identifying and managing high-risk paediatric asthma admissions to the Starlight Ward at Wythenshawe Hospital.

Methods

A retrospective case note audit was conducted of paediatric asthma admissions between 30/04/2024 and 30/04/2025. Inclusion criteria followed the National Respiratory Audit Programme. Data collected included level of care (including High-Dependency Unit [HDU] admission), oral corticosteroid use, admission frequency, specialist referrals, and documentation of asthma discharge bundles. Guideline standards required referral for all HDU admissions, patients with ≥2 courses of oral corticosteroids or ≥2 admissions within 12 months, and completion of discharge bundles for all admissions.

Seventy-nine patients accounted for 106 asthma-related admissions, including 27 repeat admissions. All HDU admissions (n=10) were appropriately referred for specialist follow-up. In contrast, only 59% of admissions involving patients with ≥2 courses of oral corticosteroids and 52% of admissions involving patients with ≥2 admissions received referrals. Overall, just 27% of admissions had a documented completed asthma discharge bundle. Patients with repeated steroid exposure accounted for the majority of repeat admissions.

While referral pathways functioned well for HDU admissions, significant gaps remain in identifying and managing other high-risk paediatric asthma patients. Inconsistent risk recognition and poor documentation likely contribute to reduced adherence to national guidance. Electronic risk-flagging, standardised admission templates, and targeted staff prompts have been introduced. This audit provides a baseline for reassessment and supports system-level interventions to improve outcomes and reduce avoidable readmissions.