Pediatric Residency Program, University of Colorado School of Medicine, Aurora, CO, USA.
Section of Pediatric Emergency Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
J Asthma. 2022 May;59(5):937-945. doi: 10.1080/02770903.2021.1881969. Epub 2021 Feb 13.
To evaluate the frequency of EMS protocol non-adherence during pediatric asthma encounters and its association with emergency department (ED) length of stay (LOS) and hospital admission.
This is a retrospective review of asthma encounters aged 2-17 years transported by EMS to a pediatric ED from 2012 to 2017. Our primary outcome was hospital admission based on prehospital protocol adherence defined as: (1) bronchodilator administration, (2) treatment of hypoxia with oxygen, or (3) administration of intramuscular (IM) epinephrine in encounters with high severity of distress. Multivariable logistic regression estimated the association between protocol non-adherence and hospital admission.
During the study period, 290 EMS encounters met inclusion criteria. Median age was 9 years (IQR 5-12), 63% were male, 40% had moderate to severe exacerbations, and 24% were admitted. Protocol non-adherence occurred in 32% of encounters with failure to administer bronchodilators in 27% and failure to administer IM epinephrine when indicated in 83%. Prehospital steroids were administered in 8% of encounters. After adjusting for covariates, protocol non-adherence was not statistically associated with likelihood of inpatient admission (OR 1.3; 95% CI: 0.6-2.6).
Among prehospital pediatric asthma encounters, EMS protocol non-adherence is common but not associated with a higher frequency of hospital admission. Hospital admission was associated with acute exacerbation severity suggesting further research is needed to develop a valid prehospital asthma severity assessment scoring tool.
Supplemental data for this article can be accessed at publisher's website.
评估儿科哮喘就诊中急诊医疗服务（EMS）协议不遵守的频率及其与急诊部门（ED）住院时间（LOS）和住院的关系。
这是对 2012 年至 2017 年通过 EMS 转运至儿科 ED 的 2-17 岁哮喘发作的回顾性研究。我们的主要结局是根据院前协议遵守情况定义的住院：（1）给予支气管扩张剂，（2）用氧气治疗缺氧，或（3）在高严重度呼吸困难的情况下给予肌肉内（IM）肾上腺素。多变量逻辑回归估计了协议不遵守与住院之间的关联。
在研究期间，290 次 EMS 就诊符合纳入标准。中位数年龄为 9 岁（IQR 5-12），63%为男性，40%有中度至重度恶化，24%住院。32%的就诊未遵守协议，其中 27%未给予支气管扩张剂，83%未在指征时给予 IM 肾上腺素。8%的就诊中给予了院前类固醇。调整了协变量后，协议不遵守与住院入院的可能性无统计学关联（OR 1.3；95%CI：0.6-2.6）。
在院前儿科哮喘就诊中，EMS 协议不遵守很常见，但与更高的住院入院率无关。住院与急性恶化严重程度相关，表明需要进一步研究以开发有效的院前哮喘严重程度评估评分工具。
本文的补充数据可在出版商的网站上获取。
