Anderson H R
Department of Public Health Sciences, St George's Hospital Medical School, London.
Thorax. 1990 Jun;45(6):431-7. doi: 10.1136/thx.45.6.431.
Trends and district variations in the pre-hospital and hospital care of children aged 0-14 years admitted with acute asthma were surveyed in all 13 districts of a health region by examining case notes for 1970, 1978, and 1985. From 1970 to 1985 there was a substantial increase in admissions and some reduction of hospital stay. Over this time adrenergic drugs remained the most frequently used treatment with a large shift towards selective beta2 agonists administered by nebulisation. Use of corticosteroids fell in the under 5s with a decrease in the parenteral route of administration but rose in the 5-14 age group with an increase in the oral route of administration. There was an increase the use of oral xanthines but this was outweighed by falls in the use of suppositories and in parenteral administration. The use of antibiotics became less frequent and that of sedatives and antihistamines fell to almost nil. There were also important changes in other aspects of management, notably an increase in the use of lung function tests (from 3% to 70%) and falls in the use of chest radiographs, blood tests, bacteriology, and physiotherapy. In nearly all aspects of management there were significant and often very extreme variations in practice between districts, which were unlikely to be explained by differences in morbidity. These variations would be a suitable focus for medical audit, with the aim of establishing which treatment regimens have the best outcome and avoiding unnecessary cost and discomfort. Because early hospital drug treatment is closely related to the type of treatment given before admission such audit activities would need to include general practitioners.
通过查阅某健康区域内所有13个地区1970年、1978年和1985年的病历，对因急性哮喘入院的0至14岁儿童的院前和院内护理的趋势及地区差异进行了调查。从1970年到1985年，入院人数大幅增加，住院时间有所缩短。在此期间，肾上腺素能药物仍然是最常用的治疗药物，且大量转向通过雾化吸入给药的选择性β2激动剂。5岁以下儿童使用皮质类固醇的情况有所下降，胃肠外给药途径减少，但5至14岁年龄组使用皮质类固醇的情况有所上升，口服给药途径增加。口服黄嘌呤的使用有所增加，但栓剂和胃肠外给药使用的减少抵消了这一增长。抗生素的使用频率降低，镇静剂和抗组胺药的使用几乎降至零。管理的其他方面也有重要变化，特别是肺功能测试的使用增加（从3%增至70%），胸部X光检查（胸透）、血液检查、细菌学检查和物理治疗的使用减少。在管理的几乎所有方面，各地区之间的实际做法都存在显著且往往非常大的差异，这些差异不太可能由发病率差异来解释。这些差异将是医疗审计的一个合适重点，目的是确定哪种治疗方案效果最佳，并避免不必要的费用和不适。由于早期医院药物治疗与入院前给予的治疗类型密切相关，此类审计活动将需要全科医生参与。
