Dominguez-Ortega Javier, Narváez-Fernández Emilio, Ramos Jacinto, Cancelliere Nataly, García-Criado Jorge, Sanchez-Ocando Humberto, Gallardo-Higueras Alicia, Dávila Ignacio
Department of Allergy, Hospital Universitario La Paz, Madrid, Spain.
Institute for Health Research, IdiPAZ, Madrid, Spain.
J Asthma Allergy. 2025 Jul 17;18:1119-1127. doi: 10.2147/JAA.S526389. eCollection 2025.
The emergency room (ER) approach for patients with asthma exacerbations (AEs) should be based on a comprehensive, multidisciplinary approach to ensure effective and timely care. This study aims to analyze the compliance level of recommended indicators, as defined in a consensus document, for the management of AEs in the ER using available electronic medical records.
An open-label, observational, non-interventional, retrospective study of adult patients treated in hospital ER for AEs was conducted at La Paz University Hospital and Salamanca University Hospital. Data were collected from medical records regarding a set of predefined measures and variables concerning asthma severity, ER stay, and subsequent discharge.
During 2019, a total of 1,019 patients accounted for 1,089 AEs were evaluated. Clinical variables predominantly included historical data, such as previous hospitalizations, Intensive Care Unit admissions, and prior exacerbations, which were recorded in 45.8% of medical records. Auscultation details were extensively documented (99.8%), yet respiratory rate (25.4%) and spirometry (less than 10%) were notably lower. Regarding discharge planning, 69.6% of patients had a defined care plan, and 59.5% received Inhaled Corticosteroids plus Long-Acting Beta-Agonists combination treatment at discharge. Medical referrals resulted in 25.5% being referred for specialized care and 87.2% to primary care. 13.3% had a specific post-discharge care timeframe.
This study highlights significant variability in the documentation and adherence to recommended indicators for AE management in the ER. Moreover, discharge planning and follow-up care were suboptimal. These findings underscore the need for improved standardization and implementation of evidence-based protocols in emergency asthma care.
哮喘急性加重（AE）患者的急诊室（ER）处理方法应基于全面、多学科的方法，以确保有效和及时的治疗。本研究旨在利用现有的电子病历，分析一份共识文件中定义的急诊室AE管理推荐指标的依从水平。
在拉巴斯大学医院和萨拉曼卡大学医院对因AE在医院急诊室接受治疗的成年患者进行了一项开放标签、观察性、非干预性、回顾性研究。从病历中收集了一组关于哮喘严重程度、急诊室停留时间和随后出院的预定义措施和变量的数据。
2019年期间，共评估了1019例患者的1089次AE。临床变量主要包括历史数据，如既往住院史、重症监护病房入院史和既往加重史，45.8%的病历中有记录。听诊细节记录详尽（99.8%），但呼吸频率（25.4%）和肺功能测定（不到10%）的记录明显较少。关于出院计划，69.6%的患者有明确的护理计划，59.5%的患者出院时接受吸入性糖皮质激素加长效β受体激动剂联合治疗。医疗转诊导致25.5%的患者被转诊至专科护理，87.2%的患者被转诊至初级护理。13.3%的患者有特定的出院后护理时间框架。
本研究突出了急诊室AE管理中记录和遵循推荐指标方面存在的显著差异。此外，出院计划和后续护理也不尽人意。这些发现强调了在急诊哮喘护理中改进标准化和实施循证方案的必要性。
