1998 OPEN FORUM Abstracts
DESCRIPTION OF ASTHMA CARE PRIOR TO APPEARING IN AN INNER CITY PEDIATRIC EMERGENCY DEPARTMENT
Timothy R. Myers RRT, Carolyn Kercsmar MD, and Robert Chatburn RRT. Rainbow Babies & Childrens Hospital and Case Western Reserve University, Cleveland, OH.
Asthma is one of the most frequent reasons for visits in emergency departments (ED). As part of our ED care path for pediatrics, all patients receive a standardized asthma history interview. This is a descriptive study of an inner city population that utilized our hospital ED for asthma care in 1997. Methods: Residents gave a standardized interview containing information regarding triggers, routine medications, pre-ED treatment, severity of illness, and healthcare utilization to all asthma ED patients. Results: There were a total of 1,555 ED visits for asthma. Visits resulted in 571 admissions (36.7%), 984 discharges (63.7%), and no deaths. The patient population was 87% non-caucasian, 64% males with a mean age of 6.3 years. Mean values for vital signs at presentation were: respiratory rate 38 breaths/ minute and SpO2 = 95%. Patient data from interviews: 18.7% had a written treatment plan, 26% contacted their private physician prior to coming to the ED, 24.5% had no medications at home, 7% had used oral steroids in the past 24 hours, and 34% of children (>= 7 years of age) had a peak flow meter at home. Below are additional data acquired from the history interviews. Chronic asthma severity determined by scoring mechanism as described in Resp Care. 98:43(1);p 25.
Current Visit Duration of Chronic Asthma
Triggers Symptoms Severity
URI 33% >12 Hours 36% Mild 36%
Weather 22% < 12 Hours 14% Moderate 15%
Exercise 20% Unknown 50% Severe 47%
Allergen 18% Unknown 2%
Routine Medications Prescribed
Albuterol 87% Oral Steroid Burst 3%
Cromolyn Sodium 44% Other 5%
Inhaled Corticosteroids 15% No Medications 10%
Pre ED Treatment in Pre ED Treatment in
past 12 hrs past 2 hrs
> 3 treatments 34% > 2 treatments 16%
No treatment 61% No treatment 75%
Unreported treatment 5% Unreported treatment 9%
ED Visits in ED Visits in Admissions in
Past Month Past Year Past Year
0 Visits 65% 0 Visits 19% 0 Visits 51%
1 Visit 27% 1-2 Visits 34% 1 Visit 41%
> 1 Visit 0% >= 3 Visits 0% >= 2 Visits 0%
Unreported 8% Unreported 46% Unreported 9%
Conclusion: Asthmatic families seem to have adequate knowledge of asthma triggers and prescribed medications, but appear not to perform the appropriate procedures prior to utilizing the ED. However; this study indicates that these families are not always adequately equipped with appropriate treatment plans or peak flow meters, or prescribed appropriate classes of medications based on disease severity.
The 44th International Respiratory Congress Abstracts-On-Disk®, November 7 - 10, 1998, Atlanta, Georgia.