Alhasoon Mohammad A, Alharbi Abdualziz N, Almohamadi Waleed S, Alsobiay Abdulrahman M, AlArmani Hudeban A, Alrehaili Abdullah M, Alamer Huthayfah A, Alsoghair Abdullah S, Alrasheedi Aeshah M
Assistant Professor, Pediatric Department, Unaizah College of Medicine, Qassim University, Buraydah, Saudi Arabia.
Medical Student, Unaizah College of Medicine, Qassim University, Buraydah, Saudi Arabia.
J Family Med Prim Care. 2020 Apr 30;9(4):2099-2103. doi: 10.4103/jfmpc.jfmpc_966_19. eCollection 2020 Apr.
Bronchial asthma has been the subject of controversy for several decades. The Global Initiative for Asthma (GINA) describes asthma as "a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness, and cough that vary over time and in intensity, together with variable expiratory airflow limitation." Although not strictly a definition, this description captures the essential features for clinical purposes. Bronchial asthma is defined as a chronic lung disease characterized by airway obstruction, inflammation and hyper-responsiveness that leads to symptoms like wheezing, coughing, chest tightening and shortness of breath especially at night or in the morning. It is one of the most common medical emergency conditions in the pediatrics all over the world. The primary care provider is the cornerstone of this study; his/her awareness about reasons of recurrent visits of emergency department by pediatric asthmatic patients would help to reduce the frequency of ED visits, which lead to minimizing the load on hospitals by addressing patient's concerns, correcting some misconceptions, and improving the patients' and their parents' knowledge and awareness.
This study aims to identify the predictors associated with frequent visits to the ED among asthmatic children at main governmental hospitals in Al-Qassim Region.
This is a cross-sectional study conducted at three different emergency departments in Qassim region such as Maternity and Children Hospital in Buraidah, King Saud Hospital in Unayzah, and Alrass General Hospital. A validated interview questionnaire was used which includes general demographic characteristics, whether the caregiver has been educated about asthma as a disease, about the use of medicines and inhalers, about the management of symptoms, reasons for using the ED for asthma care, prescription received during the ED visit, and referral from ED.
Children with less than 3 visits to ED for the last 6 months were 70.3% while those with 3 or more visits were 29.7%. Nearly all patients (88.3%) had already been diagnosed with asthma with their attending physician. The most commonly known medication was beta-agonist (62%) while the most common reason for ED visit was "to obtain oxygen" and "to obtain a bronchodilator." The prevalence of ED referral to PHC was low (9.7%). Based on the adjusted regression model, we observed that medication used (AOR = 1.760, = 0.046) and referral from ED (AOR = 3.711, < 0.001) were the significant factors being associated with 3 or more visits to ED.
Recurrent ED visitation of children with asthma was moderately low. Furthermore, medication used and referral from ED were identified as the predictors being associated with recurrent visits to ED. Further research is needed in order to validate the predictors being associated with recurrent ED visitation of asthmatic children in our region.
几十年来，支气管哮喘一直是备受争议的话题。全球哮喘防治创议（GINA）将哮喘描述为“一种异质性疾病，通常以慢性气道炎症为特征。它由喘息、气短、胸闷和咳嗽等呼吸道症状的病史定义，这些症状会随时间和强度而变化，同时伴有可变的呼气气流受限。” 尽管这并非严格意义上的定义，但该描述抓住了临床目的的基本特征。支气管哮喘被定义为一种慢性肺部疾病，其特征为气道阻塞、炎症和高反应性，会导致喘息、咳嗽、胸闷和气短等症状，尤其是在夜间或早晨。它是全球儿科最常见的医疗紧急情况之一。初级保健提供者是本研究的基石；其对儿科哮喘患者频繁就诊急诊科原因的认识，将有助于减少急诊科就诊频率，通过解决患者的担忧、纠正一些误解以及提高患者及其父母的知识和意识，从而减轻医院的负担。
本研究旨在确定卡西姆地区主要政府医院哮喘儿童频繁就诊急诊科的相关预测因素。
这是一项横断面研究，在卡西姆地区的三个不同急诊科进行，如布赖代的妇产儿童医院、乌奈宰的沙特国王医院和阿尔拉什综合医院。使用了一份经过验证的访谈问卷，其中包括一般人口统计学特征、照顾者是否接受过关于哮喘疾病的教育、药物和吸入器的使用、症状管理、因哮喘护理而使用急诊科的原因、急诊科就诊期间收到的处方以及急诊科的转诊情况。
过去6个月内就诊急诊科次数少于3次的儿童占70.3%，而就诊3次或更多次的儿童占29.7%。几乎所有患者（88.3%）已被其主治医生诊断为哮喘。最常用的药物是β-激动剂（62%），而急诊科就诊最常见的原因是 “吸氧” 和 “获取支气管扩张剂”。急诊科转诊至初级卫生保健机构的比例较低（9.7%）。基于调整后的回归模型，我们观察到使用的药物（调整后比值比[AOR]=1.760，P = 0.046）和急诊科的转诊（AOR = 3.711，P < 0.001）是与就诊急诊科3次或更多次相关的显著因素。
哮喘儿童反复就诊急诊科的情况中度偏低。此外，使用的药物和急诊科的转诊被确定为与反复就诊急诊科相关的预测因素。需要进一步研究以验证与本地区哮喘儿童反复就诊急诊科相关的预测因素。
