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Emergency Department Asthma "Spacing Trials": Institutional Variability and Time Cost.

Michael D Witting¹, Ryan M Thompson², Rami B Yanes²

¹Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland.

The Journal of Emergency Medicine

|December 11, 2020

Summary

Emergency department (ED) spacing trials for asthma exacerbations vary widely by hospital. These trials prolong ED stays by an average of 159 minutes without clear patient benefit.

Keywords:

asthma bronchodilator agents emergency service hospital hospitalization time factors

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Area of Science:

Pulmonology
Emergency Medicine
Health Services Research

Background:

Admitting physicians sometimes use medication-free intervals, or "spacing trials," in the ED for acute asthma exacerbations.
This practice aims to assess if patients can be safely admitted to a hospital ward with restricted bronchodilator access.

Purpose of the Study:

To determine the frequency of ED spacing trials across different hospital types.
To estimate the time cost associated with these spacing trials.

Main Methods:

Multicenter retrospective cohort study of asthma admissions (2015-2018).
Included university and community hospital records.
Used multivariable linear regression to analyze ED stay duration and spacing trials, adjusting for patient and hospital factors.

Main Results:

Explicit spacing trials were documented in 19% of university hospital cases versus 2% in community hospitals (17% difference).
Spacing trials were linked to an adjusted mean increase of 159 minutes in ED length of stay.
Delayed patient decompensation occurred in 3% of cases, with no significant difference between hospitals.

Conclusions:

The utilization of spacing trials for asthma exacerbations exhibits significant inter-hospital variability.
This practice is associated with considerable delays in ED stay without demonstrable clinical advantages.