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Acute paediatric asthma treatment in the prehospital setting: a retrospective observational study
Simon Craig1,2, Belinda Delardes3,4, Ziad Nehme5,6
1Paediatric Emergency Department, Monash Medical Centre Clayton, Clayton, Victoria, Australia simon.craig@monash.edu.
Insights
Few children with asthma received escalated prehospital care, such as epinephrine, from paramedics. Most pediatric asthma patients improved with standard inhaled bronchodilators before hospital arrival.
Area of Science:
- Pediatric Emergency Medicine
- Prehospital Care Research
- Respiratory Illnesses
Background:
- Asthma exacerbations are a common reason for pediatric emergency care.
- Prehospital treatment aims to stabilize patients before hospital transfer.
- Escalated care beyond standard treatments is sometimes necessary.
Purpose of the Study:
- To determine the incidence and patterns of escalated care for children with asthma receiving prehospital treatment.
- To identify factors associated with escalated care in pediatric asthma patients.
Main Methods:
- Retrospective observational study using state-wide ambulance service data.
- Included children aged 1-17 years diagnosed with asthma or treated with inhaled bronchodilators.
- Defined escalated care as parenteral epinephrine or respiratory support.
Main Results:
- Paramedics treated 1572 children for asthma exacerbations; 1.4% received escalated care (parenteral epinephrine).
- Escalated care patients were older, had prior asthma hospitalizations, and severe respiratory distress.
- Overall, 87.4% of children showed improved respiratory status upon hospital arrival.
Conclusions:
- Most children with acute asthma exacerbations do not require escalated prehospital therapy.
- Standard prehospital treatment with inhaled bronchodilators is effective for many pediatric asthma patients.
- Improved respiratory status was common upon hospital arrival for treated children.
Objectives:
To describe the incidence of and patterns of 'escalated care' (care in addition to standard treatment with systemic corticosteroids and inhaled bronchodilators) for children receiving prehospital treatment for asthma.
Design:
Retrospective observational study.
Setting:
State-wide ambulance service data (Ambulance Victoria in Victoria, Australia, population 6.5 million) PARTICIPANTS: Children aged 1-17 years and given a final diagnosis of asthma by the treating paramedics and/or treated with inhaled bronchodilators from 1 July 2019 to 30 June 2020.
Primary And Secondary Outcome Measures:
We classified 'escalation of care' as parenteral administration of epinephrine, or provision of respiratory support. We compared clinical, demographic and treatments administered between those receiving and not receiving escalation of care.
Results:
Paramedics attended 1572 children with acute exacerbations of asthma during the 1 year study period. Of these, 22 (1.4%) had escalated care, all receiving parenteral epinephrine. Patients with escalated care were more likely to be older, had previously required hospital admission for asthma and had severe respiratory distress at initial assessment.Of 1307 children with respiratory status data available, at arrival to hospital, the respiratory status of children had improved overall (normal/mild respiratory distress at initial assessment 847 (64.8%), normal/mild respiratory distress at hospital arrival 1142 (87.4%), p<0.0001).
Conclusions:
Most children with acute exacerbations of asthma did not receive escalated therapy during their pre-hospital treatment from ambulance paramedics. Most patients were treated with inhaled bronchodilators only and clinically improved by the time they arrived in hospital.
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