Hijazi Z, Abdulmalek A K, Al-Taweel F, Al-Shareda S
Department of Paediatrics, Faculty of Medicine, Kuwait University, Kuwait.
Med Princ Pract. 2002 Jul-Sep;11(3):126-30. doi: 10.1159/000063244.
To evaluate the in-patient management of children with acute exacerbation of bronchial asthma and its adherence to international guidelines.
Medical records of 100 consecutive admissions for acute exacerbation of asthma to the paediatric wards at Mubarak Al-Kabeer Hospital, Kuwait, from October through December 1999 were retrieved. Data relevant to asthma symptoms, severity, treatment regimens and discharge plan were collected and evaluated. The mean age of patients was 4.3 years, ranging from 2 to 12 years. Admissions totalled 82 males and 18 females, with hospital stays ranging from 1 to 11 days (mean = 2.6 days).
There were no fatalities. Reported episodes were severe (17%), moderate (11%) and mild (9%); degree of severity was not documented in 63 cases. Pulse, respiratory rate, colour and use of accessory muscles were not documented in 48, 48, 47 and 63% of the patients, respectively. Arterial blood gas was checked in 16 patients and pulse oximetry in 71. Full blood count, serum urea and electrolytes were obtained in 86 patients and chest radiographs in 76. All patients received nebulized salbutamol. However, some received additional medications: ipratropium bromide (79%), steroids (95%), intravenous aminophylline (5%) and antibiotics (43%). Two children were shifted to an intensive care unit, 1 of whom needed intubation. On discharge, there was no documentation of follow-up arrangements, or prophylactic anti-inflammatory drugs or other medications in 52, 81 and 32 patients, respectively.
Patient management showed deficits, and documentation was inadequate. Areas of particular concern were assessment of patients, unnecessary investigations and use of antibiotics, and lack of post-discharge planning and prophylaxis with steroids. Adherence to the international guidelines was partial.
评估支气管哮喘急性加重期儿童的住院管理情况及其对国际指南的遵循情况。
检索了科威特穆巴拉克·卡比尔医院儿科病房1999年10月至12月期间连续100例哮喘急性加重期住院病例的医疗记录。收集并评估了与哮喘症状、严重程度、治疗方案及出院计划相关的数据。患者的平均年龄为4.3岁，年龄范围在2至12岁之间。入院患者中男性82例，女性18例，住院时间为1至11天（平均 = 2.6天）。
无死亡病例。报告的发作情况为重度（17%）、中度（11%）和轻度（9%）；63例未记录严重程度。分别有48%、48%、47%和63%的患者未记录脉搏、呼吸频率、肤色及辅助呼吸肌的使用情况。16例患者进行了动脉血气检查，71例进行了脉搏血氧饱和度测定。86例患者进行了全血细胞计数、血清尿素和电解质检查，76例进行了胸部X光检查。所有患者均接受了沙丁胺醇雾化吸入治疗。然而，部分患者还接受了其他药物治疗：异丙托溴铵（79%）、类固醇（95%）、静脉用氨茶碱（5%）及抗生素（43%）。两名儿童被转至重症监护病房，其中1例需要插管。出院时，分别有52例、81例和32例患者未记录随访安排、预防性抗炎药物或其他药物。
患者管理存在不足，记录不充分。特别值得关注的方面包括患者评估、不必要的检查及抗生素使用、出院后计划的缺乏以及类固醇预防用药的不足。对国际指南的遵循情况不完全。
