Lyttle Mark D, O'Sullivan Ronan, Doull Iolo, Hartshorn Stuart, Morris Ian, Powell Colin V E
Academic Department of Emergency Care, University of the West of England, Bristol, UK Emergency Department, Bristol Royal Hospital for Children, Bristol, UK.
Department of Emergency Medicine, Cork University Hospital, Cork, Ireland School of Medicine, University College Cork, Cork, Ireland Paediatric Emergency Research Unit (PERU), National Children's Research Centre, Dublin 12, Ireland.
Arch Dis Child. 2015 Feb;100(2):121-5. doi: 10.1136/archdischild-2014-306591. Epub 2014 Aug 25.
National clinical guidelines for childhood wheeze exist, yet despite being one of the most common reasons for childhood emergency department (ED) attendance, significant variation in practice occurs in other settings. We, therefore, evaluated practice variations of ED clinicians in the UK and Ireland.
Two-stage survey undertaken in March 2013. Stage one examined department practice and stage two assessed ED consultant practice in acute childhood wheeze. Questions interrogated pharmacological and other management strategies, including inhaled and intravenous therapies.
Member departments of Paediatric Emergency Research in the United Kingdom and Ireland and ED consultants treating children with acute wheeze.
30 EDs and 183 (81%) clinicians responded. 29 (97%) EDs had wheeze guidelines and 12 (40%) had care pathways. Variation existed between clinicians in dose, timing and frequency of inhaled bronchodilators across severities. When escalating to intravenous bronchodilators, 99 (54%) preferred salbutamol first line, 52 (28%) magnesium sulfate (MgSO4) and 27 (15%) aminophylline. 87 (48%) administered intravenous bronchodilators sequentially and 30 (16%) concurrently, with others basing approach on case severity. 146 (80%) continued inhaled therapy after commencing intravenous bronchodilators. Of 170 who used intravenous salbutamol, 146 (86%) gave rapid boluses, 21 (12%) a longer loading dose and 164 (97%) an ongoing infusion, each with a range of doses and durations. Of 173 who used intravenous MgSO4, all used a bolus only. 41 (24%) used non-invasive ventilation.
Significant variation in ED consultant management of childhood wheeze exists despite the presence of national guidance. This reflects the lack of evidence in key areas of childhood wheeze and emphasises the need for further robust multicentre research studies.
国家有针对儿童喘息的临床指南，然而尽管儿童喘息是急诊就诊的最常见原因之一，但在其他环境中仍存在显著的实践差异。因此，我们评估了英国和爱尔兰急诊临床医生的实践差异。
2013年3月进行的两阶段调查。第一阶段检查科室实践，第二阶段评估急诊顾问医生对儿童急性喘息的实践。问题涉及药物和其他管理策略，包括吸入和静脉治疗。
英国和爱尔兰儿科急诊研究的成员科室以及治疗儿童急性喘息的急诊顾问医生。
30个急诊科和183名（81%）临床医生做出回应。29个（97%）急诊科有喘息指南，12个（40%）有护理路径。不同严重程度下，临床医生在吸入性支气管扩张剂的剂量、给药时间和频率方面存在差异。升级至静脉用支气管扩张剂时，99名（54%）首选沙丁胺醇作为一线用药，52名（28%）选择硫酸镁（MgSO4），27名（15%）选择氨茶碱。87名（48%）依次给予静脉用支气管扩张剂，30名（16%）同时给予，其他人则根据病例严重程度采取不同方法。146名（80%）在开始静脉用支气管扩张剂后继续进行吸入治疗。在使用静脉用沙丁胺醇的170人中，146名（86%）给予快速推注，21名（12%）给予较长的负荷剂量，164名（97%）给予持续输注，每种方法的剂量和持续时间各不相同。在使用静脉用硫酸镁的173人中，所有人仅使用推注。41名（24%）使用无创通气。
尽管有国家指南，但急诊顾问医生对儿童喘息的管理仍存在显著差异。这反映出儿童喘息关键领域缺乏证据，并强调需要进一步开展有力的多中心研究。
