Pediatric Asthma Emergency Room Visits

Asthma is a frequent childhood illness. Managing asthma can be difficult as it requires reducing environmental allergens (pollutants) and mitigating the body’s response to allergens through pharmaceuticals such as bronchodilators, inhaled or oral corticosteroids, and desensitization. When these efforts fail, an asthma attack occurs. If the attack escalates to asthmaticus status, it is a pediatric emergency. In asthmaticus status, the body doesn’t respond as it otherwise typically would to inhaled bronchodilators that can aid in opening airways. This can lead to respiratory failure and death if untreated or treated too late. In such cases, the emergency room is an appropriate place to seek care. To determine how often that happens, VHHA staff analyzed All Payer Claims Database information on pediatric asthma emergency room visits covered by Medicaid to acquire a better understanding of emergency room use by juveniles admitted with a primary diagnosis of asthma. The Medicaid population was selected because 98 percent of Medicaid bills are in the database. More than 600,000 Virginia children are covered by Medicaid – a sizable population for review. In 2015, there were 4,064 visits to emergency rooms for a primary diagnosis of asthma by Medicaid patients in Virginia. Of the Medicaid pediatric emergency patients with a primary diagnosis of asthma, the average number of visits for pediatric asthma was one, indicating that the respiratory emergencies were few that year and not frequently reoccurring. Just 16 of 4,080 such patients (0.4 percent) had five or more visits. For children with five or more visits, the majority of the visits were for asthmaticus status. When these patients visited the emergency room for something other than asthma, such visits likely were due to an upper respiratory illness (URI). Symptoms associated with an URI can mimic an impending asthma attack. In Virginia, two areas are hot spots for children with a primary diagnosis of emergency asthma visits. One is zip code 23223 (stretching from Richmond’s Shockoe Bottom to include portions of Henrico County’s east end and some of Hanover County) from which 132 pediatric asthma patients originated. This zip code has an economic distress index score of 77.2, according to the Economic Innovation Group. This is a high score and reflects a lower state of economic well-being. A score in that range often corresponds to an area with fewer businesses, fewer working adults, and income levels at about half the state average. The other is zip code is 22193 in the Woodbridge, Dale City (Prince William County) area. From that area, 78 pediatric patients went to an emergency room for asthma treatment. This zip code has a comparatively low distress index of 6.5. In summary, pediatric asthma emergencies are not common but do occur, and when they occur, reoccurrence is unlikely. The two areas with more children seeking emergency treatment for asthma – one in Central Virginia, the other in Northern Virginia – have decidedly different socioeconomic conditions.