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A treatment protocol of the acute asthma patient in a pediatric emergency department
1University of Miami School of Medicine, Florida.
Insights
This study shows a new pediatric asthma protocol effectively manages acute asthma in the emergency department, with a low rate of readmission and no deaths. The protocol was well-accepted by physicians.
Area of Science:
- Pediatric Emergency Medicine
- Pulmonology
- Clinical Protocol Development
Background:
- Acute asthma is a common pediatric emergency.
- Effective emergency department (ED) management is crucial for pediatric asthma patients.
- Standardized treatment protocols can improve care efficiency and outcomes.
Purpose of the Study:
- To evaluate the effectiveness and safety of a specific treatment protocol for pediatric acute asthma in an urban ED setting.
- To assess the short-term outcomes, including discharge rates, readmissions, and adverse events.
- To gauge physician acceptance of the implemented protocol.
Main Methods:
- A retrospective review of 682 pediatric patients (8 months to 15 years) treated for acute asthma over three months.
- Analysis of treatment interventions including aerosol inhalation, intravenous steroids, and aminophylline.
- Evaluation of patient disposition (discharge vs. admission) and subsequent 48-hour readmission rates.
- Assessment of radiographic findings for pneumonia in patients receiving intravenous medications.
Main Results:
- Out of 682 patients, 83% were discharged, and 17% were admitted; no deaths occurred.
- 100% received aerosol inhalation; 36.2% received intravenous steroids and aminophylline.
- 2.5% of discharged patients were readmitted within 48 hours for status asthmaticus.
- Pneumonia was noted in 6.2% of patients who received intravenous medications.
Conclusions:
- The established protocol demonstrates short-term effectiveness in managing pediatric acute asthma in the ED.
- The protocol is associated with a low rate of readmission and acceptable safety profile.
- Physician acceptance of the protocol was positive, indicating feasibility for routine use.
Abstract:
A treatment protocol for pediatric patients with acute asthma from 8 months to 15 years of age was utilized in an urban pediatric emergency department. In a three month period, 682 children were evaluated with acute asthma with 566 (83.0%) initially discharged and 116 (17.0%) admitted. There were no deaths. Treatment included aerosol inhalation in 682 patients (100%) and both intravenous steroids and aminophylline in 247 (36.2%) patients. Medical care was rendered by housestaff physicians supervised by full-time attending physicians. Of the 566 patients discharged, 131 (21.1%) patients had received intravenous aminophylline and steroids. Of those discharged 14 (2.5%) were admitted during the subsequent 48 hours for status asthmaticus. Of the 247 patients who received intravenous medications, chest radiographs consistent with pneumonia were noted in 15 (6.2%). The routine use of this protocol has been effective in the short term emergency department management of pediatric patients with acute asthma and had been accepted by the housestaff and attending physicians.