Ly Cynthia D, Dennehy Cathi E
University of Los Angeles, CA, USA.
Ann Pharmacother. 2007 Oct;41(10):1625-31. doi: 10.1345/aph.1K138. Epub 2007 Sep 11.
Asthma is a major health problem and the most frequent cause of chronic illness and emergency department (ED) visits in children. Limited data examining the ED management of pediatric asthma within university teaching hospitals across the US exist.
To compare the ED management of children (aged 1-17 y) with asthma at a university teaching hospital using National Asthma Education and Prevention Program (NAEPP) guidelines.
All cases of pediatric asthma that presented to the University of California, San Francisco, Medical Center ED between October 1, 2003, and October 31, 2004, were included. Patients who required hospital admission were excluded. Data pertaining to patient demographics, primary diagnosis, pharmacologic management, diagnostic tests performed, and follow-up plans were abstracted and compared with NAEPP guidelines issued in 1997 and updated topics released in 2002.
A total of 141 cases were identified. Mean patient age was 5.8 years. Most (61.7%) patients were male and of African American ethnicity (31.9%). Asthma severity was typically mild (66.7%) or moderate (29.1%). In persons at least 6 years of age (n = 58), peak expiratory flow rate (PEFR) was performed in 25.9% of cases. Pulse oximetry, however, was always performed. Based on NAEPP guidelines, beta-agonists and corticosteroids should have been used, but were not, in 2.8% and 31.9% of cases, respectively. At discharge, no corticosteroid prescription was given in 40.4% of the cases, no written action plan was prepared in 80.1% of the cases, no formal device training was administered in 67.3% of cases, and no peak flow meter was provided for persons at least 6 years of age in 50.0% of cases.
NAEPP guidelines were met in all patients regarding pulse oximetry and in most patients with respect to the use of beta-agonists. Improvements could be made, however, in the use of corticosteroids in the ED; in performing PEFR measurements for persons at least 6 years of age upon arrival; and in providing formal device training, a written action plan, prescriptions for steroids, and peak flow meters at discharge.
哮喘是一个主要的健康问题，是儿童慢性病和急诊科就诊的最常见原因。在美国各大学教学医院中，关于儿科哮喘急诊科管理的研究数据有限。
使用国家哮喘教育与预防计划（NAEPP）指南，比较一所大学教学医院中1至17岁哮喘儿童的急诊科管理情况。
纳入2003年10月1日至2004年10月31日期间在加利福尼亚大学旧金山分校医学中心急诊科就诊的所有儿科哮喘病例。排除需要住院治疗的患者。提取与患者人口统计学、初步诊断、药物治疗、所进行的诊断检查以及随访计划相关的数据，并与1997年发布的NAEPP指南和2002年发布的更新主题进行比较。
共识别出141例病例。患者平均年龄为5.8岁。大多数（61.7%）患者为男性，非裔美国人占31.9%。哮喘严重程度通常为轻度（66.7%）或中度（29.1%）。在至少6岁的患者（n = 58）中，25.9%的病例进行了呼气峰值流速（PEFR）测量。然而，脉搏血氧饱和度测定总是会进行。根据NAEPP指南，β受体激动剂和皮质类固醇应使用，但分别有2.8%和31.9%的病例未使用。出院时，40.4%的病例未开具皮质类固醇处方，80.1%的病例未制定书面行动计划，67.3%的病例未进行正式的设备培训，50.0%的至少6岁患者未获得峰值流量计。
在脉搏血氧饱和度测定方面，所有患者均符合NAEPP指南，在β受体激动剂的使用方面，大多数患者符合指南。然而，在急诊科皮质类固醇的使用、对至少6岁患者到达时进行PEFR测量以及出院时提供正式的设备培训、书面行动计划、类固醇处方和峰值流量计方面仍有改进空间。
