314 - Application of the Hospital Asthma Severity Score to Evaluate Trends for Status Asthmaticus Pre- and Post-COVID in a PICU Setting

Publication Number: 2303.314

Kimberly Pernudi, The Brooklyn Hospital Center, Brooklyn, NY, United States; Aaska Patel, The Brooklyn Hospital Center, Brooklyn, NY, United States; Carl G. Julien, The Brooklyn Hospital Center, Brooklyn, NY, United States

Background: During the pandemic, pediatric asthma admissions fell mostly due to school closures, mask use, & reduced viral transmission. Current literature provides conflicting data regarding asthma severity in hospitalized patients. The Hospital Asthma Severity Score (HASS) is a validated tool to measure asthma severity among those patients.

Objective: To compare asthma severity among patients admitted with status asthmaticus (SA) to our PICU before & after the COVID pandemic using the HASS severity score.

Design/Methods: We performed a single-center, retrospective study of patients admitted to our community hospital PICU with a diagnosis of SA from Jan '14-Dec '24. Patients were grouped into pre-(Jan '14 - Feb '20) & post-COVID(Mar '20 - Dec '24). Inclusion criteria: age 2-18 years with SA. Excluded patients were chronic lung & cardiac disease, & immunocompromised children. Demographic (age, sex, race/ethnicity) & clinical variables (accessory muscle use, respiratory support, & adjunctive therapies) were extracted from EMR & coded. HASS was calculated for each patient by a point system (hypoxia, retractions, tachypnea, respiratory support & treatment), resulting in a score range of 0-15. Severity categories defined as: mild (≤5), moderate (6-9), severe (≥10). We compared HASS & severity category between the two eras using an independent T-test & chi-square test. Statistical significance set at p< 0.05.

Results: A total of 398 PICU admissions for SA, with 280 pre-COVID & 118 post-COVID patients. Mean HASS was 7.6± 2.5 pre-COVID & 7.25± 3.0 post-COVID (p=0.27), indicating no significant difference in average severity. However, the distribution of HASS severity categories differed between eras (p=0.001). The proportion of moderate-severity admissions increased in the post-COVID period (40.7% vs 59.3% pre-COVID, p< 0.01), mild cases decreased (28.8% vs 15.7% pre-COVID, p< 0.01) and no change in proportion of severe cases (30.5% vs 25.0%, p> 0.05). This shows a shift toward moderate disease cases following the pandemic, despite decreased PICU SA admissions.

Conclusion(s): PICU admissions for SA declined in the post-COVID era. Using HASS, we found a statistically significant rise in moderate-severity cases, fewer mild cases & no change in severe cases. This trend contrasts with reports of rising severity post-COVID, reflecting differences in community and tertiary centers. Lack of severe cases may reflect early intervention & stabilization. Standardized tools like HASS are essential to track asthma patterns in post-COVID pediatric populations.

Severity Distribution of Status Asthmaticus Admission Pre- vs Post-COVID


Distribution of HASS Scores Pre-vs Post-COVID