Huabbangyang Thongpitak, Silakoon Agasak, Sangketchon Chunlanee, Sukhuntee Jareeda, Kumkong Jukkit, Srithanayuchet Tanut, Chamnanpol Parinya, Meechai Theeraphat
Department of Disaster and Emergency Medical Operation, Faculty of Science and Health Technology, Navamindradhiraj University, Bangkok, Thailand.
Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Arch Acad Emerg Med. 2023 Aug 12;11(1):e56. doi: 10.22037/aaem.v11i1.2037. eCollection 2023.
Chronic obstructive pulmonary disease (COPD) and asthma exacerbation are two common emergency situations. This study aimed to investigate the impact of pre-hospital dexamethasone initiation on treatment outcomes of these patients.
In this retrospective cross-sectional and comparative study, data from the emergency medical service (EMS) care report of patients with a final diagnosis of asthma or COPD, coded with Thailand's emergency medical triage protocol, collected between January 1, 2021, and October 31, 2022, were used. Data on baseline characteristics, emergency department length of stay (ED-LOS), and hospital admission rates were collected from electronic medical records and compared between cases with and without pre-hospital dexamethasone administration by EMS.
200 patients with COPD (n = 93) and asthma (n = 107) exacerbation were enrolled. The dexamethasone-treated group had a lower but statistically non-significant hospital admission rate (71.0% versus 81.0%, absolute difference: -10%, 95% confidence interval (CI): -21.76, 1.76; p = 0.100). In patients with asthma, the dexamethasone-treated had lower median ED-LOS time (235 (IQR: 165.5-349.5) versus 322 (IQR: 238-404) minutes; p = 0.003). Dexamethasone-treated asthma patients had lower but statistically non-significant hospital admission rates (60.4% versus 78.0%, absolute difference: -17.55%, 95% CI: -34.96, -0.14; p = 0.510). In COPD patients the dexamethasone-treated and untreated groups had non-significantly lower hospital admission rates (80.8% versus 85.40%, absolute difference: -4.60%, 95% CI: -19.82, 10.63; p = 0.561) and non-significantly lower ED-LOS (232 (IQR: 150 - 346) versus 296 (IQR: 212 - 330) minutes, absolute difference: -59 (-130.81, 12.81); p = 0.106).
The dexamethasone administration by EMS in pre-hospital setting for management of asthma and COPD patients is beneficial in reducing the ED-LOS and need for hospital admission but its effects are not statistically significant, except regarding the ED-LOS of asthma exacerbation cases.
慢性阻塞性肺疾病（COPD）和哮喘急性加重是两种常见的紧急情况。本研究旨在探讨院前使用地塞米松对这些患者治疗结局的影响。
在这项回顾性横断面比较研究中，使用了2021年1月1日至2022年10月31日期间收集的、根据泰国紧急医疗分诊方案编码的、最终诊断为哮喘或COPD患者的紧急医疗服务（EMS）护理报告数据。从电子病历中收集基线特征、急诊科住院时间（ED-LOS）和住院率数据，并对EMS进行院前地塞米松给药和未给药的病例进行比较。
纳入了200例COPD（n = 93）和哮喘（n = 107）急性加重患者。地塞米松治疗组的住院率较低，但在统计学上无显著差异（71.0%对81.0%，绝对差异：-10%，95%置信区间（CI）：-21.76，1.76；p = 0.100）。在哮喘患者中，地塞米松治疗组的ED-LOS中位数时间较短（235（四分位间距：165.5 - 349.5）对322（四分位间距：238 - 404）分钟；p = 0.003）。地塞米松治疗的哮喘患者住院率较低，但在统计学上无显著差异（60.4%对78.0%，绝对差异：-17.55%，95% CI：-34.96，-0.14；p = 0.510）。在COPD患者中，地塞米松治疗组和未治疗组的住院率无显著降低（80.8%对85.40%，绝对差异：-4.60%，95% CI：-19.82，10.63；p = 0.561），ED-LOS也无显著降低（232（四分位间距：150 - 346）对296（四分位间距：212 - 330）分钟，绝对差异：-59（-130.81，12.81）；p = 0.106）。
EMS在院前环境中对哮喘和COPD患者使用地塞米松有利于减少ED-LOS和住院需求，但其效果在统计学上不显著，哮喘急性加重病例的ED-LOS情况除外。
