Study fails to find link between guideline-based emergency treatment for pediatric asthma and patient outcomes
Adherence to guideline-based emergency treatment of children with asthma had no significant impact on patient outcome, according to the first multicenter study of the topic. The primary outcome measure was successful discharge, defined as emergency department (ED) discharge without an asthma-related return visit or ongoing symptoms in the subsequent 2 weeks. The researchers analyzed the care for 1,426 patients (58 percent mild, 33 percent moderate, and 9 percent severe asthma acuity), who were seen at one of the 14 study EDs. They looked at compliance with five process-of-care measures and two timeliness measures. Of this group, 62 percent were successfully discharged from the ED after treatment, 15 percent had either a relapse or ongoing symptoms within 2 weeks, and 24 percent were admitted to the hospital for care.
The composite score for compliance with all five receipt/nonreceipt process measures was 84 percent. For the timeliness measures, 58 percent of those children recommended to receive a systemic corticosteroid at the ED did so within the first hour; and 92 percent of those recommended to receive ED treatment with an inhaled beta-agonist did so in the first hour. However, adherence to the guideline process-of-care and timeliness measures was not associated with successful ED discharge in adjusted models. In these models, the one significant finding was that timely use of an inhaled beta-agonist increased the odds of hospitalization 4.4-fold. The researchers attribute this last finding to insufficient adjusting for severity of asthma acuity, because patients with more severe asthma are both more likely to have timely albuterol medication and more likely to be hospitalized.
This study was funded in part by the Agency for Healthcare Research and Quality (HS16418). More details are in "Multicenter analysis of quality indicators for children treated in the emergency department for asthma," by Marion R. Sills, M.D., M.P.H., Adit A. Ginde, M.D., M.P.H., Sunday Clark, Sc.D., M.P.H., and others in the February 2012 Pediatrics 129(2), pp. e325-e332.
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