The Hospital for Sick Children, Toronto, Ontario, Canada.
Respir Med. 2010 Sep;104(9):1263-70. doi: 10.1016/j.rmed.2010.03.028.
Asthma is the most common chronic disease in children. Previous studies described significant variations in acute asthma management in children. This study was conducted to examine whether asthma management in the pediatric emergency department (ED) was improved through the use of an evidence-based acute asthma care guideline reminder card.
The Pediatric Acute Asthma Management Guideline (PAMG) was introduced to the ED of a pediatric tertiary care hospital in Ontario, Canada. Medical charts of 278 retrospective ED visits (January-December 2002) and 154 prospective visits (July 2003-June 2004) were reviewed to assess changes in acute asthma management such as medication treatment, asthma education, and discharge planning. Logistic and linear regressions were used to determine the effect of PAMG on asthma management in the ED. The propensity score method was used to adjust for confounding.
During the implementation of PAMG, patients who visited the ED were more likely to receive oral corticosteroids (Adjusted Odds Ratio [AOR] = 2.26, 95% CI: 1.63-3.14, p < 0.0001) and oxygen saturation reassessment before ED discharge (AOR = 2.02, 95% CI: 1.45-2.82, p < 0.0001). They also received 0.23 (95% CI: 0.03-0.44, p = 0.0283) more doses of bronchodilator in the first hour of ED stay. Improvements in asthma education and discharge planning were noted, but the changes were not statistically significant.
After the implementation of an evidence-based guideline reminder card, medication treatment for acute asthma in the ED was significantly improved; however, asthma education and discharge planning remained unchanged. Future efforts on promoting guideline-based practice in the ED should focus on these components.
哮喘是儿童最常见的慢性病。先前的研究描述了儿童急性哮喘管理方面的显著差异。本研究旨在通过使用基于证据的急性哮喘护理指南提醒卡来检查儿科急诊（ED）的哮喘管理是否得到改善。
加拿大安大略省一家儿科三级保健医院的 ED 引入了儿科急性哮喘管理指南（PAMG）。回顾了 278 例回顾性 ED 就诊（2002 年 1 月至 12 月）和 154 例前瞻性就诊（2003 年 7 月至 2004 年 6 月）的病历，以评估急性哮喘管理方面的变化，如药物治疗、哮喘教育和出院计划。使用逻辑和线性回归来确定 PAMG 对 ED 中哮喘管理的影响。使用倾向评分法调整混杂因素。
在实施 PAMG 期间，就诊 ED 的患者更有可能接受口服皮质类固醇（调整后的优势比 [AOR] = 2.26，95%置信区间：1.63-3.14，p < 0.0001）和在 ED 出院前再次进行血氧饱和度评估（AOR = 2.02，95%置信区间：1.45-2.82，p < 0.0001）。他们在 ED 住院的第一个小时还接受了 0.23（95%置信区间：0.03-0.44，p = 0.0283）更多剂量的支气管扩张剂。注意到哮喘教育和出院计划有所改善，但这些变化没有统计学意义。
在实施基于证据的指南提醒卡后，ED 中急性哮喘的药物治疗明显改善；然而，哮喘教育和出院计划仍未改变。未来在 ED 推广基于指南的实践的工作应侧重于这些方面。
