340 - Utilization of Laboratory Tests and Imaging Among Hospitalized Children With Status Asthmaticus in a Community Hospital Setting

Publication Number: 2329.340

Ankita Nanda, The Brooklyn Hospital Center, Brooklyn, NY, United States; Carl G. Julien, The Brooklyn Hospital Center, Brooklyn, NY, United States; Amaresh Gogikar, Central Michigan University College of Medicine, Saginaw, MI, United States; Noah P. Kondamudi, The Brooklyn, Brooklyn, NY, United States

Background: Despite established guidelines on appropriate diagnostic testing for children hospitalized with status asthmaticus, unnecessary laboratory tests and imaging remain common. Such testing increases cost, patient discomfort, and may contribute to prolonged hospitalizations. Identifying drivers of this low-value care can help design targeted stewardship interventions

Objective: To quantify unnecessary laboratory and imaging utilization in children hospitalized with status asthmaticus

Design/Methods: Retrospective study using electronic medical records to identify children hospitalized with status asthmaticus between January 2022 and December 2024. Included were children aged 2-18 years admitted for status asthmaticus, and excluded were children with immunocompromised conditions and those with chronic diseases. Guideline-based criteria, Global Initiative for Asthma (GINA), 2024, and American Academy of Pediatrics (AAP) Choosing Wisely, 2022, were used to determine the appropriateness of testing, Table 1. Test performed in non-concordance with guidelines labeled as 'unnecessary testing'. Primary outcomes were the frequency of unnecessary chest X-rays and laboratory testing (CBC, BMP, LFT, magnesium, and phosphorus). Bivariate tests and multivariable logistic regression for identified predictors of unnecessary testing using SPSS for Windows version 26

Results: 190 encounters met the inclusion criteria among 139 children. The mean age was 7.8 ± 4.6 years, 63% were male, and the majority were African American (n=115, 83%). Total tests done among these patients were 472, of which 242 (51%) were deemed unnecessary. The most frequent unnecessary test performed was complete blood count in 61 encounters (61/127, 48%), Table 2. Severe asthma independently reduced the odds of unnecessary testing (adjusted odds ratio [aOR] 0.28, 95 % confidence interval [CI] 0.13-0.62; p = 0.002), and focal findings predicted appropriate test utilization (aOR 0.32, 95% CI 0.11-0.89; p = 0.029). The use of high-flow nasal cannula had higher odds (aOR 0.28, 95 % CI 0.13-0.59; p = 0.001) for appropriate testing, while those receiving low-flow oxygen had a higher odds for unnecessary testing (aOR 5.0, 95 % CI 1.05-23.97; p = 0.043), Table 3. Unnecessary testing was not associated with length of stay (2.9 ± 1.5 vs 2.8 ± 1.1 days; p = 0.81)

Conclusion(s): Over half of the children hospitalized with status asthmaticus received unnecessary testing when subjected to current management guidelines. Implementing real-time stewardship checklists and provider feedback about deviation from guidelines can reduce unnecessary utilization of tests and imaging

Table 1. Guideline-Based Appropriateness of Common Diagnostic Tests in Pediatric Status Asthmaticus (AAP Choosing Wisely 2022 and GINA 2024)
This table outlines the guideline-based indications and use of commonly ordered diagnostic tests in children hospitalized with status asthmaticus.

Table 2. Utilization and Appropriateness of Laboratory and Imaging Tests Among Hospitalized Children With Status Asthmaticus (n = 190)
Over half of all tests performed were non-guideline-concordant, with complete blood count (48 %) and basic metabolic panel (52 %) being the most frequent unnecessary studies.

Table 3. Multivariable Logistic Regression Identifying Predictors of Unnecessary Diagnostic Testing in Hospitalized Children With Status Asthmaticus
Severe asthma and focal auscultatory findings were associated with lower odds of unnecessary testing, while use of low-flow oxygen increased odds of overuse.