Emergency Department Outcomes Following Acute Asthma Exacerbations in Children: A Systematic Review

Abstract

Background: Emergency Department (ED) presentations for acute asthma are a major driver of pediatric hospital admissions. Clarifying admission risk factors can guide disposition decisions and targeted prevention. Methods: We systematically searched MEDLINE, Embase, CINAHL, and PsycINFO from inception to the final search date, following PRISMA guidance. We included studies enrolling children and adolescents with physician-diagnosed asthma presenting with acute exacerbations to the ED and reporting hospital admission outcomes. Screening, data extraction, and risk-of-bias assessment were performed independently in duplicate. Results: Eight eligible studies from diverse settings (United States, United Kingdom, Italy, Egypt, and Saudi Arabia) were included. Consistently reported admission predictors encompassed uncontrolled baseline asthma, hypoxemia at presentation (SpO₂ <90%), low peak expiratory flow at 1 hour, and clinical severity scores. Demographic and social determinants, female sex in some cohorts, minority ethnicity, and socioeconomic deprivation—were associated with higher admission probability. Modifiable factors included excess short-acting β₂-agonist use, poor adherence to controller therapy, lack of follow-up, and exposure to tobacco smoke and indoor allergens. Viral infection was the most common precipitant. Across mixed-age datasets, a meaningful proportion of ED visits resulted in admission, underscoring opportunities for risk stratification and early intervention. Conclusions: Pediatric ED admissions for acute asthma reflect an interplay of clinical severity and social determinants. Optimizing controller use, reducing environmental exposures, and ensuring structured follow-up—alongside objective ED reassessment (oxygen saturation and early PEFR) reduce avoidable admissions and improve outcomes.