Risk factors for emergency department visit in a prospective open cohort of asthmatic children

BackgroundRisk factors of emergency department (ED) visits have mainly been obtained from hospital cohorts.ObjectiveTo evaluate risk factors for ED visits in asthmatic children in an out-of-hospital cohort.MethodsWe led a prospective study in an open cohort of 933 asthmatic children followed-up by a specialized pediatrician. We measured the annualized rate of ED visits since age two and described their characteristics at last visit.ResultsMean age (± SD) at last visit was 11.1 ± 3.3 years, and the annualized rate of ED visit was 0.194 ± 0.356. Two groups were defined: one with no ED visits (n = 463), and the other with at least one ED visit (n = 470). The latter group included younger children, with multiple sensitizations and more frequent early atopic dermatitis, who reported having more inhaled corticosteroid (ICS) treatment and a more severe exacerbation rate in the three months prior to the last visit. Socioeconomic status did not influence the rate of ED visits. In a logistic regression, the absence of hospitalization before 2 years of age and of atopic dermatitis had odds ratios of 0.38 (95% confidence interval: 0.23–0.65) and of 0.57 (95% confidence interval: 0.42–0.79) respectively to predict at least one ED visit. When an asthmatic child had no early hospitalization and no atopic dermatitis, the relative risk of ED visit was decreased by 28%.ConclusionAsthmatic children with an absence of atopic dermatitis and hospitalization before two years of age are less prone to emergency department visit after age two.

Incident Heart Failure Within the First and Fifth Year after Delivery Among Women With Hypertensive Disorders of Pregnancy and Prepregnancy Hypertension in a Diverse Population

Background Hypertensive disorders of pregnancy (HDP) and pre‐pregnancy hypertension are associated with increased morbidity and mortality for the mother. Our aim was to investigate the relationships between HDP and pre‐pregnancy hypertension with maternal heart failure (HF) within 1 and 5 years of delivery and to examine racial/ethnic differences. Methods and Results We conducted a retrospective cohort study in South Carolina (2004–2016) involving 425 649 women aged 12 to 49 years (58.9% non‐Hispanic White [NHW], 31.5% non‐Hispanic Black [NHB], 9.6% Hispanic) with a live, singleton birth. Incident HF was defined by hospital/emergency department visit and death certificate data. Pre‐pregnancy hypertension and HDP (preeclampsia, eclampsia, or gestational hypertension) were based on hospitalization/emergency department visit and birth certificate data (i.e., gestational hypertension for HDP). The 425 649 women had pre‐pregnancy hypertension without superimposed HDP (pre‐pregnancy hypertension alone; 0.4%), HDP alone (15.7%), pre‐pregnancy hypertension with superimposed HDP (both conditions; 2.2%), or neither condition in any pregnancy (81.7%). Incident HF event rates per 1000 person‐years were higher in NHB than NHW women with HDP (HDP: 2.28 versus 0.96; both conditions: 4.30 versus 1.22, respectively). After adjustment, compared with women with neither condition, incident HF risk within 5 years of delivery was increased for women with pre‐pregnancy hypertension (HR,2.55, 95% CI: 1.31–4.95), HDP (HR,4.20, 95% CI: 3.66–4.81), and both conditions (HR,5.25, 95% CI: 4.24–6.50). Conclusions Women with HDP and pre‐pregnancy hypertension were at higher HF risk (highest for superimposed preeclampsia) within 5 years of delivery. NHB women with HDP had higher HF risk than NHW women, regardless of pre‐pregnancy hypertension.

Associations of Telemedicine vs. In-Person Ambulatory Care Visits on Cancellation Rates and 30-Day Follow-Up Hospitalizations and Emergency Department Visits

Importance: Studies have shown that telemedicine use in specific conditions can promote continuity of care, decreases healthcare costs, and can potentially improve clinical outcomes. The COVID-19 pandemic forced many healthcare systems to expand access for patients using telemedicine, but little is known about cancellation frequencies in telemedicine vs. in-person appointments and its impact on clinical outcomes. Objective: Compare ambulatory clinic cancellation rates, 30-day inpatient hospitalizations rates, and 30-day emergency department visit rates between in-person and video telemedicine appointments, and examine differences in cancellation rates by age, race/ethnicity, gender, and insurance. Design: A retrospective cohort study. Setting: The largest academic healthcare system in the state of Georgia with ambulatory clinics in urban, suburban and rural settings. Participants: Adults scheduled for an ambulatory clinic appointment from June 2020 to December 2020 were included. Each appointment was identified as either a video telemedicine or in-person clinic appointment. Demographics including age, race, ethnicity, gender, primary insurance, and comorbidities were extracted from the electronic medical record. Main Outcomes and Measures: The primary process outcome was ambulatory clinic cancellation rates. The primary clinical outcomes were 30-day hospitalization rates and 30-day emergency department visit rates. Multivariable logistic regression was used to assess differences in the clinical outcomes between appointment types.