2012 OPEN FORUM Abstracts
TRIAGE PRIORITY AFFECTS TIME TO INITIAL TREATMENT FOR PEDIATRIC ASTHMA PATIENTS RECEIVING CONTINUOUS ALBUTEROL IN AN ACADEMIC ED.
Andrew G. Miller, Sarah Mausert, Malissa Dunn, Kathryn Eakins, John Davies, Janice Thalman, Neil MacIntyre; Duke University Medical Center, Durham, NC
Background: Patients with severe asthma attacks often initiate the emergency medical services (EMS) system for transport to the emergency department (ED). The use of continuous albuterol has been shown to be a safe and effective treatment for severe asthma exacerbations.1 After arrival in the ED each patient is seen by a nurse and given a triage priority of 1 to 5 with 1 being the highest priority. The purpose of this review was to determine if EMS-transported pediatric asthma patients who subsequently received continuous albuterol in the ED were treated faster, had higher triage priorities or were more likely to require admission to PICU or stepdown. Methods: Records of pediatric patients placed on continuous albuterol in the Duke ED from 2/21/2009 to 4/31/2011 were retrospectively reviewed through an IRB approved protocol. Data tracked consisted of transport via EMS, triage priority, patient diagnosis, time to from triage and registration to initial bronchodilator treatment, number of treatments prior to initiation of continuous albuterol, and disposition from the ED. The need for continuous albuterol and disposition was determined by ED physician in consultation with the respiratory therapist. Results: 148 pediatric patients (age 7.5±5 years) who received continuous albuterol therapy in the ED were included. 71 (48.0%) patients (age 7.7±5.2 years) arrived via EMS transport while 77 (52.0%) patients (age 7.4±4.9 years) arrived via personal transport. The most common dose was 20 mg/hr for both EMS and non-EMS patients. The use of concomitant medications was done through standard ED guidelines and was similar in both groups. Results are displayed in the table below. In our population patients who arrived via EMS received a higher triage priority and as a result were more likely to: be admitted, treated faster with bronchodilators/steroids, require admission to PICU or stepdown and be placed immediately on continuous albuterol. Overall admission rate was high in both groups. Conclusion: Timely and effective triage of pediatric asthma is essential to provide appropriate treatment. Triage priority appears to have a significant effect on time to initial bronchodilator treatment. Development of a simple, easy to use asthma scoring system may help to further optimize appropriate triage priority. References 1. Peters, SG. Continuous Bronchodilator Therapy. Chest 2007;131(1):286-289. Sponsored Research - None