Wareham N J, Harrison B D, Jenkins P F, Nicholls J, Stableforth D E
Department of Community Medicine, Institute of Public Health, Cambridge.
Thorax. 1993 Nov;48(11):1117-20. doi: 10.1136/thx.48.11.1117.
The aim was to establish a continuing district based confidential enquiry into deaths from asthma.
A confidential enquiry was conducted in an English health district. Subjects comprised 24 residents of the Norwich health district aged between 16 and 65 years who had died between 1988 and 1991 with asthma as the principal cause of death.
Twenty one of the patients (88%) died away from hospital. Overall the routine asthma management was appropriate in all respects in only four patients. In five cases the drug treatment was considered inappropriate, in 10 cases (42%) there was no written evidence that the patient had received advice and education, and only six cases had a written management plan. In 17 patients (71%) the fatal attack of asthma developed rapidly (in under three hours). The medical care during the final attack was found to have been inappropriate in six cases. Seventeen cases (71%) had psychological or social factors that were considered to have been of potential importance.
This study has shown the feasibility of organising a confidential enquiry into asthma deaths within a health district. The distinguishing features of such an enquiry are that it is continuing, that the quality of care given to those patients who died is compared against a recognised standard, and that there is a structured system for feeding back the conclusions of the enquiry to the local medical community.
目的是在一个地区建立一项关于哮喘死亡的持续性保密调查。
在英国一个卫生区进行了一项保密调查。研究对象包括诺维奇卫生区24名年龄在16至65岁之间的居民，他们在1988年至1991年期间死亡，哮喘是主要死因。
21名患者（88%）死于院外。总体而言，仅4名患者在各方面的常规哮喘管理都是恰当的。5例患者的药物治疗被认为不恰当，10例（42%）没有书面证据表明患者接受过建议和教育，只有6例有书面管理计划。17名患者（71%）的致命哮喘发作迅速（在三小时内）。最终发作期间的医疗护理在6例中被发现不恰当。17例（71%）有被认为具有潜在重要性的心理或社会因素。
本研究表明在一个卫生区内组织关于哮喘死亡的保密调查是可行的。这种调查的显著特点是具有持续性，将死亡患者所接受的护理质量与公认标准进行比较，并且有一个将调查结论反馈给当地医学界的结构化系统。
