Association Between Timing of Albuterol and Care Escalation to the Pediatric Intensive Care Unit Within 24 Hours of Admission for Status Asthmaticus

<b>Background:</b> Children admitted to the general in-patient unit for status asthmaticus may not receive the first albuterol treatment on schedule. We sought to determine if a difference in timing between the scheduled and actual first dose of albuterol is associated with care escalation to the pediatric intensive care unit (PICU). <b>Methods:</b> We conducted a single-center case-control study of children 2-18 years admitted from the emergency department to the general in-patient unit for status asthmaticus. Cases were defined as children who required transfer to the PICU within 24 hours of admission. Groups were compared using Fisher's exact or Mann-Whitney <i>U</i> tests. Firth multivariable logistic regression estimated the adjusted association between dose timing and odds of transfer to the PICU. <b>Results:</b> Groups did not differ by demographics, comorbidities, or asthma severity risk factors. The median (IQR) time difference between the scheduled and administered first dose of albuterol was 0 (-14 to 63) min for cases and 16 (-6 to 42) min for controls <i>(P</i> = .43). Fifty percent of cases received delayed treatment compared with 63% of controls (<i>P</i> = .26). The adjusted analyses demonstrated that as the time difference between scheduled and administered albuterol increased by 1 min, odds of care escalation to the PICU remained the same (adjusted odds ratio 1.0, 95% CI: 0.9-1.0, <i>P</i> = .18). <b>Conclusions:</b> Receiving first albuterol treatment in the general in-patient unit at a time different than scheduled was not associated with increased odds of transfer to PICU.