Factors Affecting Length of Hospital Stay in Children with Moderate-to-Severe Asthma Exacerbations

BACKGROUND: Hospitalizations due to moderate to severe asthma exacerbations in children present significant challenges for health systems and families. Identifying factors affecting duration of hospitalization (DOH) is crucial for optimizing asthma management and reducing morbidity. OBJECTIVE: To investigate demographic and clinical factors associated with prolonged DOH in children hospitalized due to moderate to severe asthma exacerbations. METHODS: This prospective cohort study included 159 children aged 5-18 years hospitalized with moderate to severe asthma exacerbations in a tertiary children's hospital between January 1, 2024, and December 31, 2024. The severity of asthma exacerbations was classified using the Global Asthma Initiative criteria, and length of hospital stay was divided into two groups according to the University of California, San Francisco Consensus Guidelines for Inpatient Treatment of Asthma Patients: short-term hospital stay (≤72 hours) and long-term hospital stay (>72 hours). Demographic, clinical, and laboratory data were obtained from an electronic medical record system. RESULTS: Of 159 patients (52.8% female, median age 8 [IQR: 6-12]), 34% experienced a short-term hospital stay and 66% experienced a long-term hospital stay. The determinants of longer hospital stay, as determined by multivariate regression analysis, were weekend hospital stays (OR: 4.564,p = 0.004), number of exacerbations requiring systemic steroid treatment in the past year (OR:1.620,p = 0.012), and time spent at home before hospital admission (OR: 1.069,p < 0.001). Additionally, female gender, tobacco exposure, obesity, polysensitivity, concomitant allergic rhinitis, rhinovirus infection, and non-adherence to treatment were also significantly associated with longer hospital stays. CONCLUSION: This study demonstrated that prolonged hospital stay in children experiencing moderate to severe asthma attacks was associated with female gender, environmental tobacco exposure, obesity, previous severe exacerbations, medication non-compliance, weekend hospitalizations, and multiple sensitivities. Early diagnosis, patient education, and environmental control measures through multidisciplinary approaches are essential to reduce hospital stay and improve quality of life.