Dalcin Paulo de Tarso Roth, da Rocha Pérsio Mariano, Franciscatto Eduardo, Kang Suzie Hyeona, Menegotto Diego Milan, Polanczyk Carísi Anne, Barreto Sérgio Saldanha Menna
Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre (HCPA), RS, Brazil.
J Asthma. 2007 May;44(4):273-9. doi: 10.1080/02770900701247020.
There is a wide variability in clinical practice for treating acute asthma (AA) in the emergency department (ED), interfering in the quality of care. The purpose of this study was to evaluate the impact of a clinical pathway on the management of AA in the ED. We conducted a prospective before-after study of patients presenting with AA to the adult ED, during five separate periods (from January to March): in 2001 (pre-protocol group), 2002, 2003, 2004, and 2005 (6 months without educational reinforcement). We evaluated the effects of the recommendations on objective assessment of severity, diagnostic resource utilization, use of recommended and non-recommended therapy, and outcomes. The 2001, 2002, 2003, 2004, and 2005 groups comprised, respectively: 108, 96, 97, 98, and 101 patients. There was a significant increase in the use of pulse oximetry (8.3%, 77.1%, 88.7%, 95.9%, and 97.0%, respectively; p < 0.001). There was an increase in the use of peak expiratory flow rate from 2001 to 2004 (4.6%, 20.8%, 28.9%, and 48.0%) and a decrease after a period without educational efforts (29.7%, p < 0.001). Although the overall use of systemic corticosteroids was not changed, there was a significant increase in the use of oral steroids (p < 0.001). There was a decrease in aminophylline utilization (p = 0.005). Length of stay in the ED was significantly reduced (p = 0.04). There was no effect on hospital admission or emergency discharge (p = 0.193). The AA clinical pathway applied in the ED was associated with a positive effect on improving the quality of care.
急诊科（ED）在治疗急性哮喘（AA）方面的临床实践存在很大差异，这影响了医疗质量。本研究的目的是评估临床路径对急诊科AA管理的影响。我们对在五个不同时期（1月至3月）到成人急诊科就诊的AA患者进行了一项前瞻性前后对照研究：2001年（协议前组）、2002年、2003年、2004年和2005年（6个月无强化教育）。我们评估了这些建议对严重程度客观评估、诊断资源利用、推荐和非推荐治疗的使用以及结局的影响。2001年、2002年、2003年、2004年和2005年组分别包括：108例、96例、97例、98例和101例患者。脉搏血氧饱和度测定的使用显著增加（分别为8.3%、77.1%、88.7%、95.9%和97.0%；p<0.001）。从2001年到2004年，呼气峰值流速的使用有所增加（4.6%、20.8%、28.9%和48.0%），在一段时间没有强化教育后有所下降（29.7%，p<0.001）。虽然全身用糖皮质激素的总体使用没有变化，但口服类固醇的使用显著增加（p<0.001）。氨茶碱的使用减少（p = 0.005）。急诊科的住院时间显著缩短（p = 0.04）。对住院或急诊出院没有影响（p = 0.193）。急诊科应用的AA临床路径对改善医疗质量有积极影响。
