Beydon Nicole, Cochez Mélanie, Mahut Bruno, Tarbé de Saint Hardouin Anne-Laure, Gajdos Vincent, Régnard Delphine, Soussan-Banini Valérie, de Pontual Loïc, Delclaux Christophe
APHP, Unité Fonctionnelle de Physiologie-Explorations Fonctionnelles Respiratoires (EFR), Hôpital d'Enfants Armand-Trousseau, Paris, France.
INSERM U938 Centre de Recherche Saint Antoine, Paris, France.
Pediatr Allergy Immunol Pulmonol. 2016 Sep;29(3):130-136. doi: 10.1089/ped.2016.0646.
Emergency department (ED) visits for asthma exacerbation have not become less frequent, essentially because the self-management of mild-to-moderate asthma exacerbations by children and their families remains sub-optimal. The objective of our study was to assess the proportion of visits to EDs for asthma exacerbation that were potentially avoidable and their risk factors [such as no Written Asthma Action Plan (WAAP)]. We conducted an 8-month multicenter study in 6 French pediatric EDs. Parents, nurses, and physicians filled out a questionnaire, recording information on the history of asthma and education (peak flow, WAAP), the self-management of the present exacerbation, the reasons for coming to the ED, the severity of the exacerbation, and the clinical outcome. An ED visit was deemed as potentially avoidable when a child who had not received adequate prehospital treatment left the ED after a maximum of 3 nebulizations with a bronchodilator with no relapse within 48 h. We included 107 children [mean (standard deviation) age 9.8 (2.4) years, 40% were girls]. At arrival, 76 children [71%, 95% confidence interval (CI): 62-80] had not received adequate treatment for the current exacerbation. Forty-one children (38%, 95% CI: 29-48) had an avoidable ED visit. Feelings of fear/anxiety were the only independent risk factor for avoidable visits, whereas the existence of a WAAP at home did not independently influence avoidable visits. Inadequate prehospital treatment and avoidable visits are frequent in children with known asthma visiting EDs for an asthma exacerbation. Strategies to reduce avoidable visits should seek to improve the WAAP, to develop and validate new electronic tools for self-managed interventions, and to provide reassurance.
因哮喘急性加重而前往急诊科（ED）就诊的情况并未减少，主要原因是儿童及其家庭对轻度至中度哮喘急性加重的自我管理仍未达到最佳状态。我们研究的目的是评估因哮喘急性加重而前往急诊科就诊中可能避免的就诊比例及其危险因素[如没有书面哮喘行动计划（WAAP）]。我们在法国6家儿科急诊科进行了一项为期8个月的多中心研究。家长、护士和医生填写了一份问卷，记录有关哮喘病史和教育情况（呼气峰值流速、WAAP）、当前急性加重的自我管理、前往急诊科的原因、急性加重的严重程度以及临床结果等信息。当未接受充分院前治疗的儿童在使用支气管扩张剂最多雾化吸入3次后离开急诊科且在48小时内无复发时，该次急诊科就诊被视为可能避免的。我们纳入了107名儿童[平均（标准差）年龄9.8（2.4）岁，40%为女孩]。到达时，76名儿童[71%，95%置信区间（CI）：62 - 80]当前急性加重未得到充分治疗。41名儿童（38%，95%CI：29 - 48）有可避免的急诊科就诊。恐惧/焦虑情绪是可避免就诊的唯一独立危险因素，而家中存在WAAP并不会独立影响可避免就诊情况。在因哮喘急性加重前往急诊科就诊的已知哮喘儿童中，院前治疗不足和可避免就诊情况很常见。减少可避免就诊的策略应致力于改进WAAP、开发和验证用于自我管理干预的新电子工具，并提供安心保障。
