Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA.
Acad Emerg Med. 2011 Jul;18(7):767-70. doi: 10.1111/j.1553-2712.2011.01117.x.
This study examined how frequently inhaled corticosteroids (ICS) are prescribed at discharge in U.S. emergency departments (EDs) for children presenting with asthma exacerbations.
This was a secondary analysis of the 2005-2007 National Hospital Ambulatory Medical Care Survey (NHAMCS) database for ED visits by children 2 to 21 years old with acute respiratory symptoms and a diagnosis of asthma exacerbation. The authors determined the proportion of visits with an ICS prescription at discharge, and the associations between demographic, clinical factors, and ICS prescriptions were analyzed using logistic regression.
Between 2005 and 2007, there were 2,288,874 estimated visits by children 2 to 21 years old to U.S. EDs with asthma exacerbations, and ICS were prescribed at discharge at 4.0% of these visits (95% confidence interval [CI] = 2.4% to 5.5%). In the logistic regression model, ICS were more likely to be prescribed in the fall (adjusted odds ratio [OR] vs. spring 3.3; 95% CI = 1.0 to 11.0). Otherwise, there were no pertinent demographic or clinical factors associated with ICS prescription.
Inhaled corticosteroids are infrequently prescribed for children with asthma at discharge from U.S. EDs. Other than the fall season, there are no identified demographic or clinical factors associated with the likelihood of ICS prescriptions. ED clinicians should consider interventions to increase ICS prescriptions for children with persistent asthma.
本研究旨在调查美国急诊科（ED）在儿童哮喘急性发作时出院时开具吸入性皮质类固醇（ICS）的频率。
本研究为 2005-2007 年全国医院门诊医疗调查（NHAMCS）数据库中 2 至 21 岁儿童因急性呼吸道症状和哮喘加重而就诊的 ED 就诊的二次分析。作者确定了出院时开具 ICS 处方的就诊比例，并使用逻辑回归分析了人口统计学、临床因素与 ICS 处方之间的关系。
在 2005 年至 2007 年间，估计有 2288874 名 2 至 21 岁的儿童因哮喘加重到美国 ED 就诊，其中 4.0%（95%置信区间 [CI]：2.4%至 5.5%）的患儿在出院时开具了 ICS 处方。在逻辑回归模型中，ICS 更可能在秋季（调整后优势比 [OR]与春季相比为 3.3；95%CI：1.0 至 11.0）开出。否则，没有与 ICS 处方开具相关的明显人口统计学或临床因素。
在美国 ED 出院时，儿童哮喘患者开具 ICS 的情况很少见。除了秋季以外，没有发现与 ICS 处方开具相关的明确人口统计学或临床因素。ED 临床医生应考虑采取干预措施，增加对持续性哮喘儿童开具 ICS 处方的频率。
