A Randomized Trial to Increase Outpatient Asthma Referrals Upon Pediatric Emergency Department Discharge

This study evaluates whether use of the Pediatric Asthma Control and Communication Instrument for the Emergency Department (PACCI-ED) increased the proportion of pediatric patients referred to outpatient asthma care following a pediatric emergency department (ED) visit for an acute asthma exacerbation.

This prospective randomized controlled trial was conducted between November 2021 and April 2023. Parents of eligible children aged 5 to 11 years presenting with an acute asthma exacerbation completed the PACCI-ED. ED providers randomized to the intervention group viewed the PACCI-ED and a one-page summary of outpatient referral recommendations before patient discharge. Children were assigned to the intervention group based upon the allocation of the treating ED provider. Electronic referrals were abstracted from the medical record and nonparametric tests were used for comparisons.

Thirty-six intervention and 32 control patients were included in the analysis. Child demographic and clinical characteristics were balanced. Overall, 26.5% of children had severely uncontrolled chronic asthma. Referrals upon ED discharge were significantly greater for the intervention group (63.9% versus 6.3% in the control group, P<0.0001). Referrals were more frequently provided for patients with uncontrolled asthma (n = 18) than for patients with controlled asthma (n = 7). Most referrals were to a subspecialty clinic (28.0%) or a community asthma program (68.0%).

There was a ten-fold increase in referrals provided to children with asthma at the time of ED discharge with use of the PACCI-ED. Most referrals were for children with poorly controlled asthma who were referred to subspecialty asthma care.