2001 OPEN FORUM Abstracts
CHARACTERISTICS OF INNER-CITY CHILDRENWITH RESPIRATORY SYMPTOMS ON ADMISSION TO AN EMERGENCY DEPARTMENT: INTERVENTIONIMPLICATIONS.
Lynda Thomas Goodfellow, Ed.D.,RRT, Alice Demi RN, DNS, FAAN, Georgia State University, Atlanta, GA.
Asthma is a chronic inflammatorydisorder of the airways resulting in recurrent episodes of variable airflowobstruction, often reversible either spontaneously or with treatment. The purposeof this study was to describe the characteristics of inner-city children (ages1-11) who were admitted to an emergency department (ED) with respiratory symptoms.The research question was: What percentage of children with respiratory symptomsindicative of asthma were diagnosed as having asthma and treated for asthma?The sample consisted of all children who presented to the ED with a chief compliantof wheezing, cough, chest tightness, or shortness of breath (SOB) during a 6-weekspringtime period on 25 randomly selected shifts. These symptoms were chosenbecause they may indicate the presence of childhood asthma. A total of 582 medicalrecords were reviewed. More males (57%) than females (43%) were admitted tothe ED; the sampleÕs mean age was 4.75 years. The chief compliant in rank orderwas 1. symptoms unrelated to a respiratory ailment (28%), 2. cough (22%), 3.fever (20%), 4. wheezing (14%), 5. cold, sore throat (6%), 6. shortness of breath(5%), 7. ear ache (3%) and 8. chest tightness (1%) / asthma (1%). The primarydiagnoses recorded by physicians were: 1. wheezing (25%), 2. other related tothe respiratory system (23%), 2. other not related to the respiratory system(23%), 4. upper respiratory tract infection (URI) (13%), 5. fever (8%), 6. asthma(7%) and 7. reactive airway disease (RAD) (1%). Ninety-four percent of the children(n = 547) had a history of asthma/wheezing. Ninety-three percent (n = 541) receivedan asthma handout upon discharge while only 3 children (.5%) were referred tothe asthma clinic. The number of children given an asthma education and thenumber of children diagnosed with asthma are extremely incongruent. These findingssuggest that these young children visiting an inner city ED for asthma symptomshave poorly controlled and poorly managed chronic asthma. Traditional ED carerestricts its focus to therapy and treatment for acute exacerbations. Reimbursementissues influence the diagnosis and treatment of asthma in the acute care setting.There is a need to provide education in the school and in the home that focuseson early recognition of asthma symptoms and control, medication adherence, andidentification of asthma triggers for young children. Few programs or interventionsare targeted to the pre-school asthmatic population. As asthma management skills(self-care) and adherence improve, quality of life should also improve and numberof ED visits and hospital admissions due to asthma related exacerbations shoulddecrease.