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Asthma in emergency departments: combined adult and paediatric versus paediatric only centres
journal contribution
posted on 2004-08-01, 00:00 authored by C V E Powell, J Raftos, Debra KerrDebra Kerr, P Rosengarten, A M KellyOBJECTIVE: To compare the management of paediatric patients with mild or moderate asthma in paediatric-only emergency departments (POEDs) to treatment in a mixed adult-child emergency departments (mixed EDs). METHODS: Prospective, observational study conducted in 36 Australian emergency departments (EDs) for 2 weeks in 2001. Children aged 1-15 years with acute asthma classified as mild or moderate severity. Details of demography, severity assessment, and type of treatment facility, treatment and disposition were collected. Analysis used descriptive statistics, comparison of proportions by chi2, and multiple logistic regression. RESULTS: Two-hundred and nine children were treated at POEDs and 257 at mixed EDs. The groups had similar severity. Spacers to deliver beta-agonists were used more frequently in POEDs (67.5% vs 24.2%; P < 0.01). Children treated at POEDs with a mild attack were more likely to be admitted (20.6% vs 9.5%; P < 0.02) and given salbutamol (82.8% vs 71.9%; P = 0.03). For children with moderate asthma, oral steroid prescription on hospital discharge was more common for those treated in a mixed ED (81.0% vs 95.7%; P = 0.01). Ipratropium bromide (IB) was widely used at both types of ED but more commonly used in mixed EDs (41.7% vs 54.9%; P < 0.01). There were no differences in length-of-stay, representation rate within one month and oral steroid use for attack. Less than 2/3 of children with mild asthma attacks received steroid treatment in the ED. CONCLUSION: Treatment was similar between the two types of ED. IB was overused in mild asthma and oral steroids were underused in moderate asthma, by both ED types. Spacers were under-utilized in mixed EDs.
History
Journal
Journal of paediatrics and child healthVolume
40Issue
8Pagination
433 - 437Publisher
Wiley-BlackwellLocation
Chichester, Eng.Publisher DOI
ISSN
1034-4810Language
engPublication classification
C1.1 Refereed article in a scholarly journalCopyright notice
[2004, Wiley-Blackwell]Usage metrics
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No categories selectedKeywords
AdolescentAlbuterolAsthmaAustraliaBronchodilator AgentsChildChild, PreschoolEmergency Medical ServicesHospitals, PediatricHumansInfantIpratropiumLength of StayObservationOxygen Inhalation TherapyProspective StudiesSeverity of Illness IndexSteroidsemergency presentationpaediatricoutcometreatmentScience & TechnologyLife Sciences & BiomedicinePediatricsPRACTICE PATTERNSCHILDRENMANAGEMENTSPACERGUIDELINES
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