Heterogeneity of emergency treatment practices in wheezing preschool children

Area of Science:

• Pediatric Emergency Medicine
• Respiratory Medicine
• Clinical Practice Guidelines

Background:

• Wheezing is a common respiratory symptom in preschool children presenting to emergency rooms.
• Current emergency room (ER) treatment protocols for pediatric wheezing may not align with established evidence and guidelines.
• Inhalation device selection, administration technique, and caregiver education are critical components of effective wheezing management.

Purpose of the Study:

• To survey current treatment practices for preschool children with wheezing in Finnish emergency rooms.
• To evaluate adherence to inhalation device choice, salbutamol dosing, and caregiver instructions based on published evidence.
• To identify discrepancies between current ER protocols and established guidelines for pediatric wheezing.

Main Methods:

• A cross-sectional survey was conducted in pediatric ER units in Finnish municipalities with over 10,000 inhabitants.
• Data collection focused on inhalation device use, salbutamol administration, face mask utilization, and provision of written instructions.
• Response rate from contacted units was 50%.

Main Results:

• Over 50% of surveyed units utilized nebulizers for wheezing treatment.
• Only 13% of units administered salbutamol in single puffs, and over 30% lacked clear criteria for face mask use.
• Written action plans were provided to caregivers in only 28% of units, and proper mask-to-face seal training was documented in 20%.

Conclusions:

• Emergency room treatment guidelines for preschool children with wheezing are not consistently followed.
• Further research is required to develop effective guideline implementation strategies for primary care settings.
• Updating ER treatment protocols and re-evaluating adherence to guidelines are essential for improving pediatric wheezing management.