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Published on: November 4, 2010
Impact of prehospital pediatric asthma management protocol adherence on clinical outcomes
Alexandra L Cheetham1, Nidhya Navanandan2, Jan Leonard2
1Pediatric Residency Program, University of Colorado School of Medicine, Aurora, CO, USA.
Insights
EMS protocol non-adherence is common in pediatric asthma cases but does not increase hospital admissions. Asthma severity, not protocol adherence, predicts admission, highlighting the need for better prehospital assessment tools.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Medicine
- Health Services Research
Background:
- Pediatric asthma exacerbations frequently require emergency medical services (EMS) transport.
- Standardized protocols aim to optimize prehospital care for pediatric asthma.
- Assessing adherence to these protocols and their impact on patient outcomes is crucial.
Purpose of the Study:
- To determine the frequency of EMS protocol non-adherence in pediatric asthma encounters.
- To evaluate the association between EMS protocol non-adherence and hospital admission rates.
- To investigate the relationship between protocol adherence and emergency department length of stay.
Main Methods:
- Retrospective review of pediatric asthma encounters (ages 2-17) transported by EMS.
- Defined protocol adherence by bronchodilator administration, oxygen for hypoxia, and IM epinephrine for severe distress.
- Used multivariable logistic regression to analyze the association between non-adherence and hospital admission.
Main Results:
- 32% of 290 pediatric asthma encounters showed EMS protocol non-adherence.
- Specific failures included 27% for bronchodilators and 83% for indicated IM epinephrine.
- Protocol non-adherence was not significantly associated with increased hospital admission (OR 1.3; 95% CI: 0.6-2.6).
Conclusions:
- EMS protocol non-adherence is prevalent in pediatric asthma but does not correlate with higher hospital admission rates.
- Hospital admission appears more strongly linked to the severity of asthma exacerbations.
- Further research is needed to develop effective prehospital asthma severity assessment tools.
Objective:
To evaluate the frequency of EMS protocol non-adherence during pediatric asthma encounters and its association with emergency department (ED) length of stay (LOS) and hospital admission.
Methods:
This is a retrospective review of asthma encounters aged 2-17 years transported by EMS to a pediatric ED from 2012 to 2017. Our primary outcome was hospital admission based on prehospital protocol adherence defined as: (1) bronchodilator administration, (2) treatment of hypoxia with oxygen, or (3) administration of intramuscular (IM) epinephrine in encounters with high severity of distress. Multivariable logistic regression estimated the association between protocol non-adherence and hospital admission.
Results:
During the study period, 290 EMS encounters met inclusion criteria. Median age was 9 years (IQR 5-12), 63% were male, 40% had moderate to severe exacerbations, and 24% were admitted. Protocol non-adherence occurred in 32% of encounters with failure to administer bronchodilators in 27% and failure to administer IM epinephrine when indicated in 83%. Prehospital steroids were administered in 8% of encounters. After adjusting for covariates, protocol non-adherence was not statistically associated with likelihood of inpatient admission (OR 1.3; 95% CI: 0.6-2.6).
Conclusions:
Among prehospital pediatric asthma encounters, EMS protocol non-adherence is common but not associated with a higher frequency of hospital admission. Hospital admission was associated with acute exacerbation severity suggesting further research is needed to develop a valid prehospital asthma severity assessment scoring tool.
Abstract:
Supplemental data for this article can be accessed at publisher's website.
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