Paediatric Emergency Department, Monash Medical Centre Clayton, Clayton, Victoria, Australia
Department of Paediatrics, Monash University, Clayton, Victoria, Australia.
BMJ Open. 2023 Jun 22;13(6):e073029. doi: 10.1136/bmjopen-2023-073029.
To describe the incidence of and patterns of 'escalated care' (care in addition to standard treatment with systemic corticosteroids and inhaled bronchodilators) for children receiving prehospital treatment for asthma.
Retrospective observational study.
State-wide ambulance service data (Ambulance Victoria in Victoria, Australia, population 6.5 million) PARTICIPANTS: Children aged 1-17 years and given a final diagnosis of asthma by the treating paramedics and/or treated with inhaled bronchodilators from 1 July 2019 to 30 June 2020.
We classified 'escalation of care' as parenteral administration of epinephrine, or provision of respiratory support. We compared clinical, demographic and treatments administered between those receiving and not receiving escalation of care.
Paramedics attended 1572 children with acute exacerbations of asthma during the 1 year study period. Of these, 22 (1.4%) had escalated care, all receiving parenteral epinephrine. Patients with escalated care were more likely to be older, had previously required hospital admission for asthma and had severe respiratory distress at initial assessment.Of 1307 children with respiratory status data available, at arrival to hospital, the respiratory status of children had improved overall (normal/mild respiratory distress at initial assessment 847 (64.8%), normal/mild respiratory distress at hospital arrival 1142 (87.4%), p<0.0001).
Most children with acute exacerbations of asthma did not receive escalated therapy during their pre-hospital treatment from ambulance paramedics. Most patients were treated with inhaled bronchodilators only and clinically improved by the time they arrived in hospital.
描述接受院前治疗的哮喘儿童接受“升级治疗”（除全身皮质类固醇和吸入性支气管扩张剂标准治疗之外的治疗）的发生率和模式。
回顾性观察性研究。
全州范围的救护车服务数据（澳大利亚维多利亚州的救护车维多利亚，人口 650 万）
年龄在 1 至 17 岁之间的儿童，由治疗护理人员最终诊断为哮喘，并在 2019 年 7 月 1 日至 2020 年 6 月 30 日期间接受吸入性支气管扩张剂治疗。
我们将“治疗升级”分为肾上腺素的静脉内给药或提供呼吸支持。我们比较了接受和未接受升级治疗的患者的临床、人口统计学和治疗方法。
在 1 年的研究期间，护理人员共对 1572 名患有急性哮喘发作的儿童进行了治疗。其中 22 名（1.4%）接受了升级治疗，均接受了肾上腺素的静脉内给药。接受升级治疗的患者年龄更大，以前因哮喘需要住院治疗，初始评估时呼吸窘迫严重。在 1307 名有呼吸状况数据的儿童中，在到达医院时，儿童的呼吸状况总体上有所改善（初始评估时正常/轻度呼吸窘迫 847 例（64.8%），到达医院时正常/轻度呼吸窘迫 1142 例（87.4%），p<0.0001）。
大多数患有急性哮喘发作的儿童在接受救护车护理人员的院前治疗期间未接受升级治疗。大多数患者仅接受吸入性支气管扩张剂治疗，到达医院时临床状况有所改善。
