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Impact and Seasonality of Respiratory Viral Illnesses: A Retrospective Study
AB202 Abstracts
639
Impact and Seasonality of Respiratory Viral Illnesses: A Retrospective Study
Ashley N. Stoner, MD1, Anthony Goudie, PhD1, Jennie Stern2, and Joshua Kennedy, MD3,4; 1University of Arkansas for Medical Sciences, Little Rock, AR, 2Arkansas Children’s Hospital, Little Rock, AR, 3Arkansas Children’s Research Institute, Little Rock, AR, 4Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR. RATIONALE: We retrospectively evaluated the timing and impact of respiratory viral infections on asthma exacerbations in a children’s hospital. METHODS: We performed chart reviews of ;4500 patients from February 2012 through January of 2016 of children who received respiratory viral panel PCRs during either emergency department (ED) or inpatient admissions. Based on ICD9 and 10 codes, we found 127 of our cohort had a diagnosis associated with asthma exacerbations. Patient demographics, season of admission, length of admission, and time to viral swab were gathered to evaluate the association of socioeconomic factors, past medical history, county of residence and length of hospital stay with viral infections and asthma exacerbations. RESULTS: Overall, patients with a diagnosis of asthma exacerbation had higher rates of positive results to all viral tests (p<0.0001). However, when evaluating specific viruses and the association with asthma exacerbations, only rhinovirus (RV) was highly associated with asthma exacerbations (p<0.0001). Enterovirus/RV was most highly associated asthma exacerbations during the summer months, specifically in September (p<0.0001). We found that patients with RV and asthma exacerbations had shorter lengths of stay compared to those with asthma exacerbations in the absence of confirmed viral infection (2.8 days asthma + RV; 5.05 asthma + no virus; p<0.05). CONCLUSIONS: Viral infections are associated with asthma exacerbations; however, this association does not correlate with longer lengths of stay.
MONDAY
640
Assessment of Heterogeneity of Childhood Asthma Using Medical Informatics Approaches
Chung-Il Wi, MD1, Sunghwan Sohn, PhD2, Hongfang Liu, PhD3, Miguel A. Park, MD4, Hirohito Kita, MD5, Ivana T. Croghan, PhD3, and Young J. Juhn, MD, MPH6; 1Mayo Clinic Department of Pediatric and Adolescent Medicine, Rochester, MN, 2Mayo Clinic Rochester, Rochester, MN, 3 Mayo Clinic, Rochester, MN, 4Department of Internal Medicine: Division of Allergic Diseases, Mayo Clinic, Rochester, MN, 5Departments of Immunology and Internal Medicine, Mayo Clinic, Rochester, MN, 6 Dept of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN. RATIONALE: To identify asthmatic children for electronic medical record (EMR)-based large-scale clinical studies, we recently developed natural language processing (NLP) algorithms for two asthma criteria [Predetermined Asthma Criteria (NLP-PAC) and Asthma Predictive Index (NLP-API)]. We characterized subgroups of children with asthma using these two NLP algorithms. METHODS: We utilized the 1997-2007 Mayo Birth Cohort. We applied NLP-PAC and NLP-API algorithms to patients’ EMR and categorized them into 4 groups (Group1: both criteria positive; Group2 or 3: PAC or API only positive; Group4; both criteria negative) to characterize them with regard to demographics and asthma-related variables (i.e. asthma outcomes). RESULTS: Of the eligible 8,493 subjects, 51% were male, 82% White, and mean age (SD) at last follow-up date was 12.6 years (3.1). We identified 1,668 children (20%) as Group1, 986 (11%) as Group2, 107 (1%) as Group3, and 5,732 (67%) as Group4. As compared to other groups, Group1 were more likely to be male and had more asthma diagnosis, earlier asthma onset date, higher prevalence of allergic rhinitis and eosinophilia (p<.001 for all assessed variables). Group3 had more eczema compared to
J ALLERGY CLIN IMMUNOL FEBRUARY 2017
others (p<.001). Group1 had poorer asthma control defined by ED visit or hospitalization (p<.001) and a higher frequency of pneumonia (p<.001). CONCLUSIONS: The two NLP algorithms for asthma criteria are useful for assessing heterogeneity of asthma in clinical studies in the EMR era. Also, as these NLP algorithms identify poorly controlled asthmatics and those with asthma-related comorbidity, they are a useful population management tool for asthma care.
641
Risk Factors Associated with Asthma-Related Emergency Department and Urgent Care Visits Among Older Adults
Joy Hsu, MD, MSCI1, Jessica Chen2, and Maria Mirabelli1; 1Centers for Disease Control and Prevention, Atlanta, GA, 2Rollins School of Public Health, Emory University, Atlanta, GA. RATIONALE: Asthma morbidity is increased among older adults. Interventions to improve asthma control in this population are not welldescribed. METHODS: We investigated risk factors for asthma-related emergency department and urgent care center visits (ED/UCV) using a sample of older _65 years) with active asthma from 40 states, the District of adults (> Columbia, Guam and Puerto Rico who participated in the Behavioral Risk Factor Surveillance System Asthma Call-back Survey, a random-digit dialing survey. We conducted weighted logistic regression analyses using 2006–2010 data to compare older adults with and without asthma-related ED/UC visits with respect to clinical, environmental, and financial measures. We controlled for sociodemographic and clinical characteristics. RESULTS: Among 14,076 older adults with active asthma (representing >2.6 million persons), 10.6% (95% confidence interval _1 asthma-related ED/UCV in the past [95% CI]59.7–11.5%) reported > year. Compared to older adults without asthma-related ED/UCV, _1 asthma-related adjusted odds were higher among older adults with > ED/UCV for chronic obstructive pulmonary disease (adjusted odds ratio [aOR]52.26, 95% CI51.80–2.82), coronary artery disease (aOR51.53, 95% CI51.24–1.89), depression (aOR51.42, 95% CI51.15–1.76), diabetes (aOR51.28, 95% CI51.03–1.59), mold in the home (aOR51.61, 95% CI51.18–2.20), and cost as a barrier to accessing asthma-related health care (primary care aOR51.92, 95% CI51.31–2.81; specialty care aOR52.47, 95% CI51.57–3.90; asthma medication aOR51.87, 95% CI51.41–2.46). CONCLUSIONS: Among older adults, asthma-related ED/UCV were associated with medical comorbidities, mold in the home, and financial barriers to asthma-related health care. Interventions addressing modifiable factors could reduce asthma-related ED/UCV among older adults.
639
Impact and Seasonality of Respiratory Viral Illnesses: A Retrospective Study
Ashley N. Stoner, MD1, Anthony Goudie, PhD1, Jennie Stern2, and Joshua Kennedy, MD3,4; 1University of Arkansas for Medical Sciences, Little Rock, AR, 2Arkansas Children’s Hospital, Little Rock, AR, 3Arkansas Children’s Research Institute, Little Rock, AR, 4Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR. RATIONALE: We retrospectively evaluated the timing and impact of respiratory viral infections on asthma exacerbations in a children’s hospital. METHODS: We performed chart reviews of ;4500 patients from February 2012 through January of 2016 of children who received respiratory viral panel PCRs during either emergency department (ED) or inpatient admissions. Based on ICD9 and 10 codes, we found 127 of our cohort had a diagnosis associated with asthma exacerbations. Patient demographics, season of admission, length of admission, and time to viral swab were gathered to evaluate the association of socioeconomic factors, past medical history, county of residence and length of hospital stay with viral infections and asthma exacerbations. RESULTS: Overall, patients with a diagnosis of asthma exacerbation had higher rates of positive results to all viral tests (p<0.0001). However, when evaluating specific viruses and the association with asthma exacerbations, only rhinovirus (RV) was highly associated with asthma exacerbations (p<0.0001). Enterovirus/RV was most highly associated asthma exacerbations during the summer months, specifically in September (p<0.0001). We found that patients with RV and asthma exacerbations had shorter lengths of stay compared to those with asthma exacerbations in the absence of confirmed viral infection (2.8 days asthma + RV; 5.05 asthma + no virus; p<0.05). CONCLUSIONS: Viral infections are associated with asthma exacerbations; however, this association does not correlate with longer lengths of stay.
MONDAY
640
Assessment of Heterogeneity of Childhood Asthma Using Medical Informatics Approaches
Chung-Il Wi, MD1, Sunghwan Sohn, PhD2, Hongfang Liu, PhD3, Miguel A. Park, MD4, Hirohito Kita, MD5, Ivana T. Croghan, PhD3, and Young J. Juhn, MD, MPH6; 1Mayo Clinic Department of Pediatric and Adolescent Medicine, Rochester, MN, 2Mayo Clinic Rochester, Rochester, MN, 3 Mayo Clinic, Rochester, MN, 4Department of Internal Medicine: Division of Allergic Diseases, Mayo Clinic, Rochester, MN, 5Departments of Immunology and Internal Medicine, Mayo Clinic, Rochester, MN, 6 Dept of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN. RATIONALE: To identify asthmatic children for electronic medical record (EMR)-based large-scale clinical studies, we recently developed natural language processing (NLP) algorithms for two asthma criteria [Predetermined Asthma Criteria (NLP-PAC) and Asthma Predictive Index (NLP-API)]. We characterized subgroups of children with asthma using these two NLP algorithms. METHODS: We utilized the 1997-2007 Mayo Birth Cohort. We applied NLP-PAC and NLP-API algorithms to patients’ EMR and categorized them into 4 groups (Group1: both criteria positive; Group2 or 3: PAC or API only positive; Group4; both criteria negative) to characterize them with regard to demographics and asthma-related variables (i.e. asthma outcomes). RESULTS: Of the eligible 8,493 subjects, 51% were male, 82% White, and mean age (SD) at last follow-up date was 12.6 years (3.1). We identified 1,668 children (20%) as Group1, 986 (11%) as Group2, 107 (1%) as Group3, and 5,732 (67%) as Group4. As compared to other groups, Group1 were more likely to be male and had more asthma diagnosis, earlier asthma onset date, higher prevalence of allergic rhinitis and eosinophilia (p<.001 for all assessed variables). Group3 had more eczema compared to
J ALLERGY CLIN IMMUNOL FEBRUARY 2017
others (p<.001). Group1 had poorer asthma control defined by ED visit or hospitalization (p<.001) and a higher frequency of pneumonia (p<.001). CONCLUSIONS: The two NLP algorithms for asthma criteria are useful for assessing heterogeneity of asthma in clinical studies in the EMR era. Also, as these NLP algorithms identify poorly controlled asthmatics and those with asthma-related comorbidity, they are a useful population management tool for asthma care.
641
Risk Factors Associated with Asthma-Related Emergency Department and Urgent Care Visits Among Older Adults
Joy Hsu, MD, MSCI1, Jessica Chen2, and Maria Mirabelli1; 1Centers for Disease Control and Prevention, Atlanta, GA, 2Rollins School of Public Health, Emory University, Atlanta, GA. RATIONALE: Asthma morbidity is increased among older adults. Interventions to improve asthma control in this population are not welldescribed. METHODS: We investigated risk factors for asthma-related emergency department and urgent care center visits (ED/UCV) using a sample of older _65 years) with active asthma from 40 states, the District of adults (> Columbia, Guam and Puerto Rico who participated in the Behavioral Risk Factor Surveillance System Asthma Call-back Survey, a random-digit dialing survey. We conducted weighted logistic regression analyses using 2006–2010 data to compare older adults with and without asthma-related ED/UC visits with respect to clinical, environmental, and financial measures. We controlled for sociodemographic and clinical characteristics. RESULTS: Among 14,076 older adults with active asthma (representing >2.6 million persons), 10.6% (95% confidence interval _1 asthma-related ED/UCV in the past [95% CI]59.7–11.5%) reported > year. Compared to older adults without asthma-related ED/UCV, _1 asthma-related adjusted odds were higher among older adults with > ED/UCV for chronic obstructive pulmonary disease (adjusted odds ratio [aOR]52.26, 95% CI51.80–2.82), coronary artery disease (aOR51.53, 95% CI51.24–1.89), depression (aOR51.42, 95% CI51.15–1.76), diabetes (aOR51.28, 95% CI51.03–1.59), mold in the home (aOR51.61, 95% CI51.18–2.20), and cost as a barrier to accessing asthma-related health care (primary care aOR51.92, 95% CI51.31–2.81; specialty care aOR52.47, 95% CI51.57–3.90; asthma medication aOR51.87, 95% CI51.41–2.46). CONCLUSIONS: Among older adults, asthma-related ED/UCV were associated with medical comorbidities, mold in the home, and financial barriers to asthma-related health care. Interventions addressing modifiable factors could reduce asthma-related ED/UCV among older adults.