Asthma: audit of peak flow rate guidelines for admission and discharge

Area of Science:

• Pediatric Pulmonology
• Emergency Medicine
• Clinical Decision Support

Background:

• Asthma is a common pediatric respiratory illness requiring careful management in emergency settings.
• Decisions regarding hospital admission versus discharge for pediatric asthma exacerbations can be challenging for casualty officers.

Purpose of the Study:

• To evaluate the utility of peak expiratory flow rate (PEFR) in guiding casualty officers' decisions for admitting or discharging children with asthma.
• To assess the impact of PEFR-based admission and discharge guidelines on clinical practice and patient outcomes.

Main Methods:

• A two-part, 8.5-month study involving recording PEFR, treatment, and disposition for children presenting with asthma.
• Part 1 established baseline data, while Part 2 implemented and evaluated admission/discharge guidelines based on PEFR thresholds.

Main Results:

• The proportion of children admitted with a PEFR >= 40% of expected post-treatment decreased from 43% to 26%.
• Admissions for children with PEFR > 60% of expected fell significantly from 23% to 5%.
• No significant change was observed in the rate of patient reattendance.

Conclusions:

• Peak expiratory flow rate (PEFR) is a valuable tool for reducing unnecessary hospital admissions in pediatric asthma cases.
• Effective implementation requires appropriate reference values and clear clinical guidelines for casualty officers.