In-Hospital Outcomes and Mortality of Pediatric Asthma Exacerbations in Thailand: A Nationwide Study (2015–2022)

Rattapon Uppala,1 Phanthila Sitthikarnkha,1 Sirapoom Niamsanit,1 Leelawadee Techasatian,1 Suchaorn Saengnipanthkul,1 Kaewjai Thepsuthammarat,2 Jamaree Teeratakulpisarn,1 Pope Kosalaraksa1 1Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 2Clinical Epidemiology Unit, Faculty of Medicine, Khon Kaen University, Khon Kaen, ThailandCorrespondence: Phanthila Sitthikarnkha, Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, Tel +6643363012, Email [email protected]: Asthma is a chronic respiratory disorder that is prevalent and significantly contributes to morbidity and mortality among children globally. However, national data regarding in-hospital outcomes and factors associated with complications and mortality in Thailand remain limited. This study aims to quantify in-hospital outcomes among children hospitalized due to asthma exacerbations and identify factors associated with complications and mortality.Patients and Methods: We performed a nationwide retrospective study in Thailand. Pediatric patients aged under 18 years admitted due to asthma exacerbation from January 2015 to December 2022 were identified. Multivariate logistic regression models were utilized to identify factors associated with endotracheal intubation.Results: Among 283,014 pediatric patients admitted with asthma exacerbations, 62.9% were male, and 62.3% were younger than 6 years. Acute respiratory failure requiring endotracheal intubation occurred in 6,452 admissions (2.3%), predominantly among children under 6 years of age. Pneumonia, pneumothorax, and hypokalemia were frequently observed among intubated patients. Admission rates showed consistent peaks in August and September, with a notable decline in 2021 corresponding to COVID-19 pandemic-related healthcare disruptions. The overall in-hospital mortality rate was 0.1% (195 deaths among 283,014 admissions), with annual population-based mortality rates ranging from 0.11 to 0.26 per 100,000 population. Deaths occurred disproportionately among adolescents and patients treated at tertiary-level hospitals, and were commonly accompanied by severe complications including pneumonia, pneumothorax, and hypokalemia.Conclusion: This nationwide study demonstrates a substantial burden of pediatric asthma hospitalizations in Thailand, with rare but clinically significant mortality. Fatal outcomes clustered among adolescents and children experiencing severe complications, highlighting the importance of early recognition, timely escalation of care, and optimized management of high-risk patients to prevent avoidable asthma-related deaths.Keywords: asthma exacerbation, intubation, children, mortality