Acute asthma in children: evaluation of management in a hospital emergency department.

To test the premise that asthma in children is treated erratically and often inappropriately, we studied the medical records of children with asthma presenting to the emergency department of a paediatric teaching hospital over a 12-month period. Four hundred and twenty-two patients (10% of those eligible) were selected; they ranged in age from 5 months to 17 years with a mean age of 5.4 years and a male to female ratio of 1.6:1. Eighty-six per cent of patients were self referred and 53% had a documented history of asthma. Thirty-seven per cent of patients were not taking medication at the time of presentation and 19% had been prescribed antibiotics. Documentation of physical findings in the medical record was generally inconsistent. For the vast majority of patients the treatment given was a nebulised beta-agonist, with 30% receiving oral corticosteroids. Seventy-six per cent of patients were able to be discharged from the emergency department, but 10% of these patients re-presented during the same attack. When discharged, 98% of patients were taking beta-agonists, 23.5% theophylline and 29% corticosteroids (usually a short oral course). For over one-third of patients attending the emergency department no documented follow-up arrangements were made. The poor documentation of severity and the variability of treatment of asthma among physicians, both in the community and in the emergency department, is cause for concern. There is a need for further education of health professionals in the appropriate assessment, documentation and treatment of asthma in children.