Acute obstructive respiratory tract diseases in a pediatric emergency unit: evidence-based evaluation
Related Experiment Videos
Ayse Kilic1, Emin Ünüvar, Murat Sütçü
1Division of Ambulatory Pediatrics, University of Istanbul, Istanbul, Turkey. ayse.kilic@tnn.net
Insights
Pediatric emergency units showed low rates of antibiotic use and chest X-rays for asthma, bronchiolitis, and croup. Steroid use was high in severe asthma and croup cases, indicating appropriate management for these conditions.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Illnesses in Children
- Healthcare Quality Improvement
Background:
- Asthma, bronchiolitis, and croup are common pediatric respiratory conditions requiring emergency care.
- Evaluating diagnostic and treatment performance in pediatric emergency units is crucial for optimizing patient outcomes.
- Evidence-based guidelines inform appropriate management strategies for these pediatric respiratory illnesses.
Purpose of the Study:
- To assess the performance of a pediatric emergency unit in diagnosing and treating asthma, bronchiolitis, and croup.
- To evaluate adherence to evidence-based criteria in the management of pediatric respiratory emergencies.
- To identify areas for improvement in the diagnostic and therapeutic approaches for common childhood respiratory conditions.
Main Methods:
- Retrospective cross-sectional study using emergency department records and data.
- Performance evaluation based on National Hospital Ambulatory Medical Care Survey criteria.
- Analysis of diagnostic test utilization (chest X-ray, hemogram, biochemical tests) and medication prescribing patterns (antibiotics, corticosteroids) in relation to symptom severity.
Main Results:
- Chest X-rays were more frequently used in severe cases of bronchiolitis and croup, and in severe asthma.
- Hemogram and biochemical tests were requested more often in severe cases across all three conditions.
- Antibiotic use was minimal, while steroid administration was high in severe asthma and croup, and moderate/severe bronchiolitis.
Conclusions:
- The pediatric emergency unit demonstrated low rates of antibiotic administration and chest X-ray utilization for asthma, bronchiolitis, and croup.
- Appropriate steroid use was observed in severe asthma attacks and croup cases.
- Findings suggest a generally evidence-based approach to managing these pediatric respiratory conditions, with potential for further refinement.
Objectives:
The objective of this study was to determine the evidence-based performance of the pediatric emergency unit in the diagnosis of and treatment approach to the patients with asthma, bronchiolitis, and croup.
Methods:
In this study conducted in a retrospective cross-sectional way, emergency cards and computer data have been used. In the performance evaluation, the National Hospital Ambulatory Medical Care Survey criteria were considered. In the evaluation of performance in diagnosis, the rates of chest x-ray studies and use of corticosteroids and antibiotics were examined. Use of antibiotics in the cases not having a fever or any symptoms of bacterial infection and failure in prescribing steroids to the cases with moderate-to-severe symptoms were considered as bad performance criteria. χ(2) test was used for the data, which can be classified; Mann-Whitney U and Student t tests were used for the data with normal distribution and for the continuous variables.
Results:
Study groups were composed of 2795 patients (1742 cases with asthma, 115 cases with croup, 938 cases with bronchiolitis) aged between 3 and 140 months (mean [SD], 41.2 [31] months). Chest x-ray study was requested significantly more often in the cases of bronchiolitis and croup with severe symptoms. In asthma cases, chest x-ray study was requested in those with severe clinical symptoms. In all 3 groups, a significant difference between the severity levels of the cases, from whom hemogram was requested, was determined. Biochemical tests were requested more often in those with severe bronchiolitis or asthma. Antibiotics were prescribed to none of the mild bronchiolitis cases. However, steroids were recommended more often to patients with moderate and severe bronchiolitis. They were administered to all patients with croup. Systemic steroids were prescribed more often to those with moderate or severe asthma.
Conclusions:
In our unit, both antibiotics administration and chest x-ray studies requested in patients with bronchiolitis, croup, and asthma were in low rates. Steroids in asthma attacks were found to be high in severe cases and in croup cases as well.
Related Concept Videos
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:19Respiratory Assessment: Purpose and Indications
Objectives and Importance:
The primary goal of respiratory assessment is to evaluate patients at early risk of clinical deterioration. Since respiratory distress often precedes other signs of declining health, breathing patterns and sounds become a...
01:23Assessment of Respiration
Subjective Assessment: Nurses interview the patient to gather information directly during the subjective assessment. It includes questions about the individual's medical history, medications, and symptoms, focusing on past respiratory conditions like asthma or COPD,...
01:20Assessment of Ventilation I: Respiratory Rate
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation:
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
01:17Pulmonary Cycle: Exhalation