Tsai Chu-Lin, Rowe Brian H, Sullivan Ashley F, Camargo Carlos A
Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Ann Allergy Asthma Immunol. 2009 Oct;103(4):318-24. doi: 10.1016/S1081-1206(10)60531-5.
Little is known about factors associated with systemic corticosteroid (SC) use in emergency department (ED) patients with acute asthma.
To determine the patient and system factors associated with delayed use or nonuse of SCs in the ED.
We analyzed the asthma component of the National Emergency Department Safety Study. Patients with acute asthma in 62 urban EDs in 23 US states between 2003 and 2006 were identified. The primary outcome measure was the pattern of SC use in the ED, which was categorized as timely use (< or = 60 minutes), delayed use (> 60 minutes), or nonuse. Multinomial logistic regression was performed to identify factors associated with delayed use or nonuse of SCs.
A total of 2,559 of 3,798 patients with acute asthma (67.4%) received SCs. Of these, the median door-to-SC time was 62 minutes (interquartile range, 35-100 minutes), with 1,319 patients (51.5%) having delayed SC treatment. Nonuse of SCs was largely explained by markers of asthma exacerbations (never intubated for asthma, lower respiratory rate, and higher oxygen saturation). In contrast, in addition to these factors, delayed SC treatment was associated with age of 40 years or older, female sex, longer duration of symptoms, ED presentation between 8 AM and 11:59 PM, and ED with a longer average patient wait time.
Physicians in the ED seem to appropriately administer SCs to higher-acuity asthmatic patients; however, the additional nonmedical factors represent opportunities to improve the timeliness of SC treatment in the ED.
对于急诊科急性哮喘患者使用全身性皮质类固醇（SC）的相关因素知之甚少。
确定急诊科延迟使用或未使用SC的患者及系统因素。
我们分析了国家急诊科安全研究中的哮喘部分。确定了2003年至2006年间美国23个州62家城市急诊科的急性哮喘患者。主要结局指标是急诊科SC的使用模式，分为及时使用（≤60分钟）、延迟使用（>60分钟）或未使用。进行多项逻辑回归以确定与延迟使用或未使用SC相关的因素。
3798例急性哮喘患者中共有2559例（67.4%）接受了SC治疗。其中，从就诊到使用SC的中位时间为62分钟（四分位间距，35 - 100分钟），1319例患者（51.5%）接受SC治疗延迟。哮喘加重的指标（从未因哮喘插管、较低的呼吸频率和较高的氧饱和度）很大程度上解释了未使用SC的情况。相比之下，除了这些因素外，延迟SC治疗还与年龄在40岁及以上、女性、症状持续时间较长、上午8点至晚上11点59分之间到急诊科就诊以及患者平均等待时间较长的急诊科有关。
急诊科医生似乎对病情较重的哮喘患者适当使用了SC；然而，这些额外的非医疗因素为改善急诊科SC治疗的及时性提供了机会。
