2010 OPEN FORUM Abstracts
A METERED DOSE INHALER BASED ACUTE ASTHMA TREATMENT PROTOCOL IS AN EFFECTIVE AND EFFICIENT PROCESS FOR CHILDREN WITH MILD TO MODERATE ASTHMA EXACERBATIONS IN AN URBAN PEDIATRIC EMERGENCY DEPARTMENT.
Keyvan Rafei1, Getachew Teshome1, Mary Beth Bollinger2; 1Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Maryland Baltimore, Baltimore, MD; 2Department of Pediatrics, Division of Pediatric Pulmonology/Allergy, University of Maryland Baltimore, Baltimore, MD
BACKGROUND: Asthma accounts for a significant proportion of pediatric Emergency Department (ED) visits and is one of the leading causes of childhood hospitalization. Multiple studies have demonstrated that metered dose inhalers with valved holding chambers (MDI-VHC) are effective modalities for delivery of beta-agonists in the treatment of acute asthma. Compared to nebulizers, MDI-VHCs have been shown to lead to reduced hospitalization rates, shortened ED stays and decreased costs. However, the use of MDI-VHC in the ED based treatment of acute asthma remains limited. Between 2003 and 2010 the Pediatric ED at the University of Maryland Hospital for Children (UMHC) embarked on an effort to develop and implement a MDI-VHC based asthma protocol for children with mild to moderate acute asthma and demonstrate its effectiveness. METHODS: A retrospective search of the electronic medical records was conducted to identify patients treated for the complaint of acute asthma (ICD-9 Code 493.) between January 1st and December 31st 2009 in the Pediatric ED. Patients with acute asthma were identified based on their chief complaint, enrollment in asthma protocol and/or final discharge diagnosis. RESULTS: Between January 1 and December 31, 2009, a total of 1115 patients were treated for acute asthma in the Pediatric ED. The patient age range was 2-18 years with a median age of 6 years and 60% were male. Eighty one percent of patients were treated with MDI-VHCs only, 8% were treated with nebulizers only and 11% were treated with both modalities. Inpatient admission rates were 1.3% for those treated solely with MDI-VHCs, 51% for those treated solely with nebulizers and 52% for those treated with both modalities. For those who did not require inpatient admission, the average Emergency Department length of stay was 186 minutes for the MDI-VHC only group, 290 minutes for the nebulizer only group and 335 minutes for those treated with both modalities. Among those discharged from the ED, the 72-hour return rate was 2.1% for those treated solely with MDI-VHCs, 2.2% for those treated solely with Nebulizers and 5.0% for those treated with both modalities. CONCLUSIONS: A metered dose inhaler based asthma protocol can be an effective and efficient process for the treatment of mild to moderate acute asthma exacerbations in the 2 to 18-year age group. Sponsored Research - None Treatment outcomes by aerosol delivery modality