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A one-year series of pediatric emergency department wheezing visits: the Hawaii EMS-C project
L G Yamamoto1, R A Wiebe, W J Matthews
1Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu.
Insights
Pediatric wheezing exacerbations are influenced by environmental factors and infections. Initial oxygen saturation (OSAT) and a proposed treatment history system can objectively assess severity in the emergency department.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Medicine
- Environmental Health
Background:
- Wheezing is a common respiratory symptom in pediatric patients presenting to emergency departments.
- Factors influencing wheezing exacerbations require further investigation to optimize patient management.
- Current assessment methods may lack objectivity in determining disease severity.
Purpose of the Study:
- To analyze factors affecting daily wheezing exacerbations in pediatric patients.
- To evaluate the correlation between initial oxygen saturation and disease severity.
- To propose a novel system for categorizing asthma treatment based on patient history.
Main Methods:
- A 12-month observational study of 2468 pediatric patients with wheezing in a pediatric emergency department.
- Data collection included patient demographics, medical history, concurrent infections, and medication use.
- Analysis of seasonal variations, weather, air quality, infections, and initial oxygen saturation (OSAT).
Main Results:
- The hospitalization rate was 10.5%.
- Seasonal variations, weather, air quality, and infections significantly impacted daily wheezing exacerbations.
- Initial OSAT strongly correlated with hospitalization risk and bronchodilator treatment needs.
Conclusions:
- Environmental factors and infections play a significant role in pediatric wheezing exacerbations.
- Initial oxygen saturation is a valuable objective marker for assessing wheezing severity.
- A proposed treatment categorization system, combined with pulse oximetry, can enhance objective assessment and management of wheezing in the ED.
Abstract:
During a 12-month period ending on November 30, 1988, data were collected on 2468 pediatric patients with wheezing who visited a pediatric ED. Cohort characteristics included: sex (64% male, 36% female), history of prematurity (12%), evidence of concurrent infection (82%), taking theophylline (35%), taking beta adrenergics (60%), taking cromolyn (6%), and taking corticosteroids (4%). The hospitalization rate was 10.5%. Seasonal variations, weather, air quality, and infections appeared to have significant effects on the daily variation of wheezing exacerbations. Initial oxygen saturation (OSAT) correlated with disease severity as measured by hospitalization risk and the number of bronchodilator treatments required in the ED. A suggestion for categorizing the treatment of asthma based on past history is proposed. Using this system in conjunction with pulse oximetry, wheezing severity and appropriate therapy can be more objectively determined.