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Management of acute childhood asthma: a prospective multicentre study
T N Hilliard1, H Witten, I A Male
1Royal Alexandra Hospital for Sick Children, Brighton, UK.
Insights
UK pediatric asthma care shows room for improvement. While systemic steroids were common, initial oxygen saturation monitoring and documented patient education were low, indicating a need to enhance acute asthma management in children.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Pediatrics
Background:
- Acute asthma is a leading cause of pediatric hospital admissions.
- Established national guidelines exist for managing childhood asthma.
- Current UK management practices for acute pediatric asthma admissions require evaluation.
Purpose of the Study:
- To assess the adherence to national guidelines in the UK for managing children admitted with acute asthma.
- To identify areas for improvement in the clinical care of pediatric asthma patients.
- To analyze data from a large cohort of children hospitalized for acute asthma.
Main Methods:
- Prospective data collection over one year (February 1995-January 1996) across ten UK centers.
- Utilized an admission pro forma and a computer-based information management system.
- Studied 1,578 admissions involving 1,352 children aged 1-14 years.
Main Results:
- 62% of admitted children were under 5 years old.
- Initial arterial oxygen saturation (Sa,O2) was recorded in 63% of admissions; peak expiratory flow rate in 36% of those over 5.
- Systemic steroids were administered to 78%; lower Sa,O2 (<92%) correlated with longer hospital stays and intravenous treatment. Preventative treatment increased from 42% to 53% from admission to discharge.
- Documented patient education rates were low.
Conclusions:
- Despite national guidelines, significant opportunities exist to improve acute asthma management in UK pediatric hospital admissions.
- Enhancing Sa,O2 monitoring and patient education are key areas for intervention.
- Further research and implementation strategies are needed to optimize care for children with acute asthma.
Abstract:
Children with acute asthma account for a significant proportion of paediatric hospital admissions, and clear guidelines exist for their care. The aim of this study was to determine their management in the UK. Over 1 year (February 1995 to January 1996), children aged 1-14 yrs admitted with acute asthma were studied in both teaching and district general hospitals. An admission pro forma was used to collect data prospectively, with a computer-based information management system for the input of admissions in each centre. Ten centres collected data prospectively, with 1,578 admissions involving 1,352 children (median age 3.6 yrs). Sixty two per cent of children were <5 yrs of age. Sixty three per cent of admissions had initial arterial oxygen saturation (Sa,O2) recorded, and, in those older than 5 yrs, 36% had their initial peak expiratory flow rate recorded. Systemic steroids were given to 78%. An initial Sa,O2 of <92% was associated with a longer stay in hospital, and also with intravenous treatment. Preventative treatment increased from 42% on admission to 53% on discharge. The rates of documented education were low. This is the largest UK study following publication of national guidelines and shows that there is still room for improvement in the management of children admitted with acute asthma.