Provision of Guideline-Based Pediatric Asthma Care in US Emergency Departments

Area of Science:

• Pediatric Emergency Medicine
• Health Services Research
• Respiratory Medicine

Background:

• National guidelines recommend corticosteroids and discourage routine chest radiographs (CXRs) and antibiotics for pediatric acute asthma care.
• Adherence to these guidelines in emergency departments (EDs) varies, impacting patient outcomes.
• Understanding performance differences between pediatric and general EDs is essential for targeted quality improvement initiatives.

Purpose of the Study:

• To assess adherence to national asthma care guidelines in pediatric and general emergency departments.
• To compare rates of corticosteroid use, antibiotic prescription, and CXR acquisition between pediatric and general EDs.
• To identify factors associated with guideline-based care for pediatric asthma patients.

Main Methods:

• Analysis of the National Hospital Ambulatory Medical Care Survey (2005-2015) for pediatric asthma visits treated with albuterol.
• Definition of guideline-based care as corticosteroid administration, no antibiotics, and no CXR.
• Comparison of guideline adherence rates between pediatric and general EDs using multivariable analyses.

Main Results:

• Over 7 million eligible ED visits were analyzed.
• General EDs had significantly higher rates of antibiotic (20% vs 11%) and CXR (40% vs 26%) use compared to pediatric EDs.
• Overall guideline adherence was 34%, with pediatric EDs showing higher rates (42% vs 31%).
• Pediatric ED visits and Black race were independently associated with guideline-based care.

Conclusions:

• Guideline-based asthma care is more prevalent in pediatric EDs but remains suboptimal, with only one-third of visits meeting criteria.
• Significant variation exists in the use of antibiotics and CXRs for pediatric asthma patients.
• Future efforts should focus on policy and education to reduce unnecessary interventions and improve adherence to asthma management guidelines.