Related Experiment Videos
Interventions for educating children who have attended the emergency room for asthma
M M Haby1, E Waters, C F Robertson
1Centre for Community Child Health, Royal Children's Hospital, Flemington Rd, Parkville, Victoria, Australia, 3052. habym@cryptic.rch.unimelb.edu.au
Insights
Asthma education for children visiting the emergency department did not significantly reduce future visits or hospital admissions. More research is needed to clarify the effectiveness of asthma management education for pediatric patients.
Area of Science:
- Pediatric Pulmonology
- Health Services Research
- Evidence-Based Medicine
Background:
- Asthma is a leading cause of pediatric hospital admissions, incurring significant community costs.
- Effective asthma education may prevent numerous hospitalizations.
- This review focuses on children who have sought emergency care for asthma.
Purpose of the Study:
- To systematically review literature on the impact of asthma education on health outcomes in children after emergency department visits for asthma.
Main Methods:
- Searched major databases (Cochrane Airways Group, Medline, Embase, Cinahl) and reference lists.
- Included randomized controlled trials (RCTs) and controlled clinical trials (CCTs) of asthma education.
- Two reviewers independently assessed quality and extracted data; authors were contacted for additional information.
Main Results:
- Eight trials (1407 patients) were analyzed; education was nurse- or researcher-led.
- Asthma education did not reduce subsequent emergency department visits (RR=0.87), hospital admissions (RR=0.74), or unscheduled doctor visits (RR=0.74) compared to controls.
- Significant heterogeneity was observed across studies, including subgroup analyses.
Conclusions:
- Current evidence does not firmly support asthma education for reducing healthcare utilization in children post-emergency asthma care.
- Some trials suggested benefits, but reasons for discrepancies with negative studies remain unclear.
- Further research is necessary to establish the efficacy of asthma education interventions.
Background:
Asthma is one of the most common reasons for paediatric admissions to hospital, with substantial cost to the community. There is some evidence to suggest that many hospital admissions could be prevented with effective education about asthma and its management.
Objectives:
To conduct a systematic review of the literature in order to identify whether asthma education leads to improved health outcomes in children who have attended the emergency department for asthma.
Search Strategy:
We searched the Cochrane Airways Group trials register, including Medline, Embase, and Cinahl databases, and reference lists of trials and review articles.
Selection Criteria:
Randomised controlled trials or controlled clinical trials of asthma education for children who had attended the emergency department for asthma, with or without hospitalisation, within the previous 12 months.
Data Collection And Analysis:
Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information.
Main Results:
Eight trials involving 1407 patients were included, in all the education was provided by nurses or researchers. Compared to control (usual care or lower intensity education) education did not reduce subsequent emergency department (ED) visits [4 trials; relative risk (RR)= 0.87, 95% confidence interval (CI) 0.37 to 2.08], hospital admissions [5 trials; RR=0.74, 95% CI 0.38 to 1.46] and unscheduled doctor visits [5 trials; RR= 0.74, 95% CI 0.49 to 1.12). Each analysis showed evidence of heterogeneity among the studies (P<0.01). Subgroup analyses by the overall difference in scale of intervention between treatment and control groups (comprehensive programme versus information only) or the timing of the intervention/recruitment (early versus delayed) gave similar results to the main analysis and still revealed significant heterogeneity between trials.
Reviewer'S Conclusions:
On the basis of the published trials, there is no firm evidence to support the use of asthma education for children who have attended the emergency department for asthma as a means of reducing subsequent ED visits, hospital admissions or unscheduled doctor visits. Some trials appeared to show clear evidence of benefit, but reasons for differences between these and the negative studies is not clear. More research is required