Asthma Presentations by Children to Emergency Departments in a Canadian Province: A Population-Based Study

Background: Asthma has a high prevalence in North American children and exacerbations presenting to the emergency department (ED) setting are common. Objective: Describe the epidemiology of asthma presentations to EDs by children residing in a large geographic area (Alberta, Canada). Methods: Data were extracted from provincial administrative databases for children < 18 years of age from April 1999 to March 2005. Information extracted included demographics, ED visit timing, and subsequent visits to non-ED settings. Analysis included summaries and rates. Results: A total of 94,187 ED visits for asthma (45,385 children) were obtained. Visits were more common by boys (61.3%); after age 14, more females presented. The standardized rates remained stable over time; 21.1/1,000 in 1999/2000 compared to 19.8/1,000 in 2004/2005. Welfare recipients and Aboriginals had higher rates than other groups. Important daily, weekly, and monthly trends were seen. Approximately 10% were admitted; 5.4% of those discharged had a repeat ED visit within 7 days and 71% had not completed a non-ED follow-up visit within 7 days. The median time to the first follow-up visit was 26 days. Conclusions: Acute asthma is an important and relatively common ED presentation in childhood. Despite guidelines and improved treatments, this study failed to identify decreased presentation rates over time; disparities were based on age, sex, and socio-economic/cultural status. Few children were reassessed within a week of their ED visit. Further study is required to understand the factors associated with these variations and the effectiveness of interventions targeted at specific groups to reduce the asthma-related ED visits. Pediatr Pulmonol. 2010; 45:985-992. (C) 2010 Wiley-Liss, Inc.