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Asthma treatment and outcomes for children in the emergency department and hospital.
J Asthma. 2018 06; 55(6):603-608.JA

Abstract

OBJECTIVE

To describe and compare the treatment of acute asthma exacerbations in children given in the emergency department (ED) and admitted to acute care floor in the hospital or intensive care unit (ICU).

METHODS

A retrospective chart review of visits for acute exacerbation of asthma treated at Phoenix Children's Hospital between January 1, 2014 and December 31, 2016.

RESULTS

A total of 287 asthma exacerbation cases were identified including 106 (37%) ED visits, 134 (47%) hospital floor and 47 (16%) ICU admissions. A history of a previous ED visit (ED 88%, Floor 60% and ICU 68%; p < 0.0001) and prior pulmonology inpatient consultation (ED 30%, Floor 19% and ICU 15%; p = 0.05) varied significantly. Pulmonology inpatient consultations were performed more frequently in the ICU than on the hospital floor (54% versus 8%; p < 0.0001). Although overall 145 (51%) of the cases were already on inhaled corticosteroids (ICS) at the time of visit with no differences across locations, ICS initiation/step-up was greater in the ICU (72%) than on the hospital floor (54%) and ED (2%) (p < 0.0001). A recommendation given to the family for follow-up with pulmonology was more frequent for patients who had been admitted to the ICU (68%) as compared to those only admitted to the floor (31%) or ED (4%) (p < 0.0001). Readmission rates were similar for patients previously admitted to the hospital (Floor 42%; ICU 40%), but significantly higher for previous ED visits (77%) (p < 0.0001).

CONCLUSIONS

Physicians in the ED have an opportunity to provide preventative care in the acute care setting and should be encouraged to initiate treatment with ICS. Consideration should be given to develop a program or clinical pathway focused on long-term asthma management and maintenance to reduce readmissions and long hospital stays.

Authors+Show Affiliations

a Phoenix Children's Hospital , Phoenix , AZ , USA.a Phoenix Children's Hospital , Phoenix , AZ , USA.a Phoenix Children's Hospital , Phoenix , AZ , USA.a Phoenix Children's Hospital , Phoenix , AZ , USA.a Phoenix Children's Hospital , Phoenix , AZ , USA.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

28820610

Citation

Drewek, Rupali, et al. "Asthma Treatment and Outcomes for Children in the Emergency Department and Hospital." The Journal of Asthma : Official Journal of the Association for the Care of Asthma, vol. 55, no. 6, 2018, pp. 603-608.
Drewek R, Mirea L, Rao A, et al. Asthma treatment and outcomes for children in the emergency department and hospital. J Asthma. 2018;55(6):603-608.
Drewek, R., Mirea, L., Rao, A., Touresian, P., & Adelson, P. D. (2018). Asthma treatment and outcomes for children in the emergency department and hospital. The Journal of Asthma : Official Journal of the Association for the Care of Asthma, 55(6), 603-608. https://doi.org/10.1080/02770903.2017.1355381
Drewek R, et al. Asthma Treatment and Outcomes for Children in the Emergency Department and Hospital. J Asthma. 2018;55(6):603-608. PubMed PMID: 28820610.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Asthma treatment and outcomes for children in the emergency department and hospital. AU - Drewek,Rupali, AU - Mirea,Lucia, AU - Rao,Aparna, AU - Touresian,Peter, AU - Adelson,Philip David, Y1 - 2017/09/08/ PY - 2017/8/19/pubmed PY - 2019/8/14/medline PY - 2017/8/19/entrez KW - Asthma KW - asthma exacerbation KW - emergency department KW - inhaled corticosteroids KW - pediatrics SP - 603 EP - 608 JF - The Journal of asthma : official journal of the Association for the Care of Asthma JO - J Asthma VL - 55 IS - 6 N2 - OBJECTIVE: To describe and compare the treatment of acute asthma exacerbations in children given in the emergency department (ED) and admitted to acute care floor in the hospital or intensive care unit (ICU). METHODS: A retrospective chart review of visits for acute exacerbation of asthma treated at Phoenix Children's Hospital between January 1, 2014 and December 31, 2016. RESULTS: A total of 287 asthma exacerbation cases were identified including 106 (37%) ED visits, 134 (47%) hospital floor and 47 (16%) ICU admissions. A history of a previous ED visit (ED 88%, Floor 60% and ICU 68%; p < 0.0001) and prior pulmonology inpatient consultation (ED 30%, Floor 19% and ICU 15%; p = 0.05) varied significantly. Pulmonology inpatient consultations were performed more frequently in the ICU than on the hospital floor (54% versus 8%; p < 0.0001). Although overall 145 (51%) of the cases were already on inhaled corticosteroids (ICS) at the time of visit with no differences across locations, ICS initiation/step-up was greater in the ICU (72%) than on the hospital floor (54%) and ED (2%) (p < 0.0001). A recommendation given to the family for follow-up with pulmonology was more frequent for patients who had been admitted to the ICU (68%) as compared to those only admitted to the floor (31%) or ED (4%) (p < 0.0001). Readmission rates were similar for patients previously admitted to the hospital (Floor 42%; ICU 40%), but significantly higher for previous ED visits (77%) (p < 0.0001). CONCLUSIONS: Physicians in the ED have an opportunity to provide preventative care in the acute care setting and should be encouraged to initiate treatment with ICS. Consideration should be given to develop a program or clinical pathway focused on long-term asthma management and maintenance to reduce readmissions and long hospital stays. SN - 1532-4303 UR - https://www.unboundmedicine.com/medline/citation/28820610/Asthma_treatment_and_outcomes_for_children_in_the_emergency_department_and_hospital_ L2 - https://www.tandfonline.com/doi/full/10.1080/02770903.2017.1355381 DB - PRIME DP - Unbound Medicine ER -