Acute asthma in a children's emergency room: a clinical audit and management guideline proposal

Adequate asthma control in children includes optimal medical management of acute exacerbations of the disorder. Asthma guidelines provide critical information and serve as quick reference decision-support material for clinicians.

This clinical audit aimed at evaluating emergency management of acute asthma as well as proposing for use a management protocol, with the view of improving quality of care.

This is a retrospective audit of the management of acute asthma over 18 months (October 2000-April 2002) Relevant data related to diagnostic and therapeutic procedures in thirty asthmatics were extracted and examined.

There were 20 males and 10 females (M:F ratio 2:1). Mean age (range) was 5.9 years (10 months-12.5 years) and mean (range) duration of symptoms prior to presentation was 1.9 days (2 hours-8 days). Trigger factors, current medications, clinical and functional indices of severity of acute asthma were not documented in 73.3%, 93.3% and 96.7% cases respectively. Diagnostic labels used in 28 (93.3%) did not reflect the acute nature or severity of the acute episode. Although nebulized salbutamol and oral corticosteroids were used for 80.0% of cases, aminophylline was frequently prescribed in addition. Discharge medications and instructions, including follow up in the respiratory clinic were not given in 21 (70.0%) and 28 (93.3%) cases respectively.

This audit noted that the overall management of acute asthma in the emergency room and the documentation of crucial information vital in the acute and long-term care of asthmatics were inadequate. We propose and recommend for use in the Children's Emergency Room, acute asthma management guideline and protocol-based asthma paper records as well as computerization of patient records.