Abstract
Background
Guidelines recommend an inhaled corticosteroid (ICS) on emergency department (ED)
discharge after acute asthma exacerbations.
Objective
We sought to identify rates and predictors of ICS prescription at ED discharge. Secondary
outcomes included ICS prescription rates in a high-risk subgroup, outpatient follow-up
rates within 30 days, and variation in ICS prescriptions among attending emergency
physicians. Methods: This was a retrospective cohort study of adult asthma ED discharges
for acute asthma exacerbation across 5 urban academic hospitals. We used multivariable
logistic regression to evaluate predictors of ICS prescription after adjusting for
patient characteristics and hospital-level clustering.
Results
Among 3948 adult ED visits, an ICS was prescribed in 6% (n = 238) of visits. Only
14% (n = 552) completed an outpatient visit within 30 days. Among patients with 2
or more ED visits in 12 months, the ICS prescription rate was 6.7%. ICS administration
in the ED (odds ratio [OR] 9.91; 95% CI 7.99–12.28) and prescribing a β-agonist on
discharge (OR 2.67; 95% CI 2.08–3.44) were associated with higher odds of ICS prescription.
Decreased odds of ICS prescription were associated with Hispanic ethnicity (OR 0.71;
95% CI 0.51–0.99) relative to Black race, and private (OR 0.75; 95% CI 0.62–0.91)
or no insurance (OR 0.54; 95% CI 0.35–0.84) relative to Medicaid. One-third (36%,
n = 66) of ED attendings prescribed 0 ICS prescriptions during the study period.
Conclusions
An ICS is infrequently prescribed on ED asthma discharge, and most patients do not
have an outpatient follow-up within 30 days. Future studies should examine the extent
to which ED ICS prescriptions improve outcomes for patients with barriers to accessing
primary care.
Keywords
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Article info
Publication history
Published online: February 28, 2023
Accepted:
February 17,
2023
Received in revised form:
January 31,
2023
Received:
October 10,
2022
Publication stage
In Press Uncorrected ProofFootnotes
Michelle Lin is currently at Stanford Department of Emergency Medicine, Palo Alto, CA.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
