Crain E F, Weiss K B, Fagan M J
Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA.
Arch Pediatr Adolesc Med. 1995 Aug;149(8):893-901. doi: 10.1001/archpedi.1995.02170210067012.
To determine whether US emergency department care for pediatric asthma conforms to the National Institutes of Health guidelines and whether the guidelines are likely to be adopted in clinical practice.
Mail survey conducted from January to April 1992, and stratified by hospital type (children's, public and community).
Emergency departments of US hospitals.
Simple stratified random sample of emergency department directors from 376 sampled hospitals.
Self-reported data on emergency department pediatric asthma care, and knowledge and attitudes about the National Institutes of Health guidelines. Data are reported as mean (+/- SE).
Sixty-eight percent of the surveyed emergency department directors responded. During 1991, there were an estimated 1.6 million visits for pediatric asthma care. Asthma accounted for 16.9% (+/- 9.0%) of all pediatric emergency department visits. Only 2.1% (+/- 1.0%) reported the use of written protocols or guidelines, with significant variation by hospital type. Sixty-seven percent (+/- 3.0%) reported the use of pulse oximetry. Eighty percent reported the use of beta-agonists by inhalation as the initial treatment. Only 44.7% (+/- 2.9%) reported the use of steroids if there was a poor response to the initial treatment. An estimated 45.5% (+/- 3.9%) of respondents had heard of the guidelines at the time of this survey; approximately 24% reported that they had read the guidelines. Most respondents reported that the guidelines were credible, clear and concise, and likely to be adopted in their emergency department.
These data suggest that reported pediatric asthma care in US emergency departments differs substantially from the National Institutes of Health guidelines, with considerable variation by hospital type. The guidelines appear to provide an acceptable tool for emergency departments to use in assessing their pediatric asthma care. However, in light of the lack of evidence that the guidelines will improve outcomes, the impact of national guideline adoption remains unclear.
确定美国急诊科对小儿哮喘的治疗是否符合美国国立卫生研究院的指南，以及这些指南在临床实践中是否可能被采用。
1992年1月至4月进行的邮件调查，按医院类型（儿童医院、公立医院和社区医院）分层。
美国医院的急诊科。
从376家抽样医院的急诊科主任中抽取的简单分层随机样本。
关于急诊科小儿哮喘治疗的自我报告数据，以及对美国国立卫生研究院指南的了解和态度。数据以均值（±标准误）报告。
68%的受访急诊科主任回复了调查。1991年期间，估计有160万次小儿哮喘治疗就诊。哮喘占所有小儿急诊科就诊的16.9%（±9.0%）。只有2.1%（±1.0%）报告使用了书面方案或指南，不同医院类型之间存在显著差异。67%（±3.0%）报告使用了脉搏血氧饱和度测定法。80%报告使用吸入型β受体激动剂作为初始治疗。只有44.7%（±2.9%）报告在初始治疗反应不佳时使用类固醇。估计45.5%（±3.9%）的受访者在本次调查时听说过这些指南；约24%报告他们读过这些指南。大多数受访者报告说这些指南可信、清晰简洁，并且可能会在他们的急诊科被采用。
这些数据表明，美国急诊科报告的小儿哮喘治疗与美国国立卫生研究院的指南有很大差异，不同医院类型之间存在相当大的差异。这些指南似乎为急诊科评估其小儿哮喘治疗提供了一个可接受的工具。然而，鉴于缺乏证据表明这些指南会改善治疗结果，采用国家指南的影响仍不明确。
