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An audit and international comparison of asthma management in the emergency department
M J Epton1, C Skidmore, J J O'Hagan
1Emergency Department, Christchurch Hospital, New Zealand.
Insights
This audit found that acute asthma management in Christchurch Hospital was comparable to other centers in New Zealand and the UK. Asthma severity markers at presentation also showed no significant differences between Christchurch and Southampton.
Area of Science:
- Emergency Medicine
- Respiratory Medicine
- Clinical Audit
Background:
- Asthma management requires adherence to established guidelines for optimal patient outcomes.
- Emergency departments are crucial points for acute asthma care.
- International comparisons are valuable for assessing healthcare standards.
Purpose of the Study:
- To audit acute asthma management at Christchurch Hospital.
- To compare Christchurch's asthma care with Wellington (NZ) and Southampton/Leicester (UK).
- To compare asthma severity markers between these centers.
Main Methods:
- Adult patients with acute asthma attending Christchurch Hospital ED were recorded.
- Data collected via specially designed asthma treatment sheets.
- Comparisons made with data from similar studies in Wellington, Southampton, and Leicester.
Main Results:
- 759 cases analyzed; peak age group 15-25 years.
- Peak flow measurement performed in 79% on admission, 67% post-treatment.
- Nebulized bronchodilators used in 88%; parenteral steroids in 22%.
- 46% discharged, 28% received oral prednisone; management aligned with severity indices.
Conclusions:
- Acute asthma treatment in Christchurch was of a similar standard to other comparable centers.
- Asthma severity on presentation, measured by peak flow and pulse rates, did not differ significantly between Christchurch and Southampton.
Aims:
1. To perform an audit of asthma management in the Christchurch Hospital emergency department during the period March 1987 to August 1988. 2. To compare management of asthma in Christchurch with other centres in New Zealand and the United Kingdom. 3. To compare markers of asthma severity on admission with other centres.
Methods:
Details of all attendances by adults to the Christchurch Hospital emergency department with acute asthma during the above period were recorded on specially designed asthma treatment sheets. This data was compared with similar studies performed in Wellington (NZ) and Southampton and Leicester (UK).
Results:
759 cases were analysed. Most subjects were in the 15-25 year age group. 47% were taking inhaled corticosteroids at presentation. History taking was satisfactory according to guidelines operative at that time. Peak flow rate measurement at presentation was performed in 79% of cases, and in 67% of cases following treatment. Nebulised bronchodilators were given in 88% of cases and parenteral steroids given in 22%. 46% of cases were discharged home and of these 28% received a course of oral prednisone. All management decisions, except the decision to give oral steroids on discharge, showed a relationship to objective indices of asthma severity.
Conclusion:
Comparison with other centres shows that the treatment of acute asthma in Christchurch was of a similar standard. Severity of asthma on presentation, as measured by peak flow and pulse rates showed no difference between Christchurch and Southampton.