Alexandra L Cheetham1, Nidhya Navanandan2, Jan Leonard2, Kelsey Spaur3, Geoffrey Markowitz3, Kathleen M Adelgais2. 1. Pediatric Residency Program, University of Colorado School of Medicine, Aurora, CO, USA. 2. Section of Pediatric Emergency Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA. 3. University of Colorado School of Medicine, Aurora, CO, USA.
Abstract
OBJECTIVE: To evaluate the frequency of EMS protocol non-adherence during pediatric asthma encounters and its association with emergency department (ED) length of stay (LOS) and hospital admission. METHODS: This is a retrospective review of asthma encounters aged 2-17 years transported by EMS to a pediatric ED from 2012 to 2017. Our primary outcome was hospital admission based on prehospital protocol adherence defined as: (1) bronchodilator administration, (2) treatment of hypoxia with oxygen, or (3) administration of intramuscular (IM) epinephrine in encounters with high severity of distress. Multivariable logistic regression estimated the association between protocol non-adherence and hospital admission. RESULTS: During the study period, 290 EMS encounters met inclusion criteria. Median age was 9 years (IQR 5-12), 63% were male, 40% had moderate to severe exacerbations, and 24% were admitted. Protocol non-adherence occurred in 32% of encounters with failure to administer bronchodilators in 27% and failure to administer IM epinephrine when indicated in 83%. Prehospital steroids were administered in 8% of encounters. After adjusting for covariates, protocol non-adherence was not statistically associated with likelihood of inpatient admission (OR 1.3; 95% CI: 0.6-2.6). CONCLUSIONS: Among prehospital pediatric asthma encounters, EMS protocol non-adherence is common but not associated with a higher frequency of hospital admission. Hospital admission was associated with acute exacerbation severity suggesting further research is needed to develop a valid prehospital asthma severity assessment scoring tool. Supplemental data for this article can be accessed at publisher's website.
OBJECTIVE: To evaluate the frequency of EMS protocol non-adherence during pediatric asthma encounters and its association with emergency department (ED) length of stay (LOS) and hospital admission. METHODS: This is a retrospective review of asthma encounters aged 2-17 years transported by EMS to a pediatric ED from 2012 to 2017. Our primary outcome was hospital admission based on prehospital protocol adherence defined as: (1) bronchodilator administration, (2) treatment of hypoxia with oxygen, or (3) administration of intramuscular (IM) epinephrine in encounters with high severity of distress. Multivariable logistic regression estimated the association between protocol non-adherence and hospital admission. RESULTS: During the study period, 290 EMS encounters met inclusion criteria. Median age was 9 years (IQR 5-12), 63% were male, 40% had moderate to severe exacerbations, and 24% were admitted. Protocol non-adherence occurred in 32% of encounters with failure to administer bronchodilators in 27% and failure to administer IM epinephrine when indicated in 83%. Prehospital steroids were administered in 8% of encounters. After adjusting for covariates, protocol non-adherence was not statistically associated with likelihood of inpatient admission (OR 1.3; 95% CI: 0.6-2.6). CONCLUSIONS: Among prehospital pediatric asthma encounters, EMS protocol non-adherence is common but not associated with a higher frequency of hospital admission. Hospital admission was associated with acute exacerbation severity suggesting further research is needed to develop a valid prehospital asthma severity assessment scoring tool. Supplemental data for this article can be accessed at publisher's website.
Entities:
Keywords:
EMS; Emergency Medical Services; acute exacerbation; child; epinephrine; hospital admission; length of stay; pediatric; prehospital; protocol; steroid
Authors: C S Kelly; C L Andersen; J P Pestian; A D Wenger; A B Finch; G L Strope; E F Luckstead Journal: Ann Allergy Asthma Immunol Date: 2000-05 Impact factor: 6.347
Authors: E Brooke Lerner; Peter S Dayan; Kathleen Brown; Susan Fuchs; Julie Leonard; Dominic Borgialli; Lynn Babcock; John D Hoyle; Maria Kwok; Kathleen Lillis; Lise E Nigrovic; Prashant Mahajan; Alexander Rogers; Hamilton Schwartz; Joyce Soprano; Nicholas Tsarouhas; Samuel Turnipseed; Tomohiko Funai; George Foltin Journal: Prehosp Emerg Care Date: 2013-10-17 Impact factor: 3.077