A Prospective Multicenter Study of Patient Factors Associated With Hospital Admission From the Emergency Department Among Children With Acute Asthma

Pollack, Charles V.; Pollack, Emily S.; Baren, Jill M.; Smith, Sharon R.; Woodruff, Prescott G.; Clark, Sunday; Camargo, Carlos A.

doi:10.1001/archpedi.156.9.934

Cited by 71 publications

(37 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…19,20 The contrast between our negative study and the positive process-outcome association found by its closest counterpart, the adult EMNet study, 8 may reflect 2 confounders. 21 First, the 2 studies differed in how they adjusted for patient-level factors, including severity.…”

Section: Discussioncontrasting

confidence: 56%

“…24 Second, we studied only the initial processes of asthma care; several studies revealed that data from the time of ED disposition, rather than from arrival, is more predictive of outcomes. 18,20,25 Third, our secondary hypothesis used the outcome admission, a heterogeneous decision based on the clinical opinion of individual providers. The subjectiveness of this secondary outcome is why we selected the composite outcome successful discharge as our primary outcome.…”

Section: Discussionmentioning

confidence: 99%

“…12,13,19,20 Demographic information included age, gender, race/ethnicity, parental education (high school graduate, yes/no), median household income, insurance status, and presence of a primary care provider.…”

Section: Other Measuresmentioning

confidence: 99%

See 2 more Smart Citations

Multicenter Analysis of Quality Indicators for Children Treated in the Emergency Department for Asthma

et al. 2012

View full text Add to dashboard Cite

WHAT'S KNOWN ON THIS SUBJECT: Studies of the association between process and outcome measures of the quality of acute asthma care for children have been mixed. These studies are limited by small, single-institution settings or by examining the association at the aggregate level. WHAT THIS STUDY ADDS:This first multicenter analysis of the process-outcome association in acute asthma care for children revealed no association. Because the validity of process measures depends on association with outcomes, further study is needed before implementing existing process measures as performance metrics.abstract OBJECTIVE: To test the hypothesis that an association exists between process and outcome measures of the quality of acute asthma care provided to children in the emergency department.METHODS: Investigators at 14 US sites prospectively enrolled consecutive children 2 to 17 years of age presenting to the emergency department with acute asthma. In models adjusted for variables commonly associated with the quality of acute asthma care, we measured the association between 7 measures of concordance with national asthma guideline-recommended processes and 2 outcomes. Specifically, we modeled the association between 5 receipt/nonreceipt process measures and successful discharge and the association between 2 timeliness measures and admission.RESULTS: In this cohort of 1426 patients, 62% were discharged without relapse or ongoing symptoms (successful discharge), 15% were discharged with relapse or ongoing symptoms, and 24% were admitted. The composite score for receipt of all 5 receipt/nonreceipt process measures was 84%, and for timeliness measures, 57% receive a timely corticosteroid and 92% a timely b-agonist. Our adjusted models showed no association between process and outcome measures, with 1 exception: timely b-agonist administration was associated with admission, likely reflecting confounding by severity rather than a true process-outcome association. CONCLUSIONS:We found no clinically significant association between process and outcome quality measures in the delivery of asthma-related care to childreninamulticenterstudy.Althoughthequalityofemergencydepartment care does not predict successful discharge, other factors, such as outpatient care, may better predict outcomes. Pediatrics 2012;129:e325-e332 AUTHORS:

show abstract

Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Multicenter Analysis of Quality Indicators for Children Treated in the Emergency Department for Asthma

et al. 2012

View full text Add to dashboard Cite

show abstract

“…[6][7][8][9][10] Recurrent ED visits and hospitalizations are risk factors for fatal asthma. 11 After medication use, hospitalization-related costs accounted for the largest total direct cost for asthma care in 1994.…”

mentioning

confidence: 99%

Improving Pediatric Asthma Care Through Surveillance: The Illinois Emergency Department Asthma Collaborative

Lenhardt¹,

Catrambone²,

McDermott³

et al. 2006

Pediatrics

View full text Add to dashboard Cite

OBJECTIVES. To better understand and improve the care of asthma patients who require emergency department (ED) care, the Illinois Emergency Department Asthma Collaborative (IEDAC) was created to develop, test, and disseminate an ED-based surveillance system. This report describes the development and testing of the pediatric IEDAC surveillance instruments and demonstrates how these instruments can be used to describe the health status, healthcare delivery, and outcome of children using ED services.METHODS. A convenience sample of 128 children presenting to 5 EDs in Illinois for asthma care was the study base. Data were collected on monthly samples of children aged 2 through 17 years who presented to these EDs from May to November 2003. Three instruments were used to collect data regarding the children's pre-ED, ED, and post-ED experience.RESULTS. At the ED visit, 73.4% of children met national guideline criteria for persistent-level asthma symptoms. Among this group, 53.2% were using inhaled corticosteroid (ICS) medications. At 1 month follow-up, 66.6% of the children met the criteria for persistent-level asthma symptoms, which was statistically unchanged from the ED visit. Among the latter group, 64.2% were using ICS medications, again statistically unchanged compared with the ED visit. At followup, 24.5% of children were reported to have returned to an ED or were subsequently hospitalized. The majority of children were noted at follow-up to have limitation of at least some activity.CONCLUSIONS. Children who presented to IEDAC EDs were found to have a high level of asthma burden that continued at follow-up despite treatment. Moreover, a substantial proportion of children had returned to an ED or were subsequently hospitalized. Encouraging trends in medication use were observed, although suboptimal medication use was also observed.

show abstract

“…Unfortunately, there is no consensus on which factor, or combination of factors, is most predictive of severe disease and need for hospital admission. 3 Previous studies have evaluated the effectiveness of various tools in assessing disease severity. Limited data suggest that initial oxygen saturation reliably predicts outcome in children presenting to the emergency department (ED) with acute asthma.…”

mentioning

confidence: 99%

End-tidal Carbon Dioxide Measurements in Children with Acute Asthma

2007

View full text Add to dashboard Cite

Objectives: A noninvasive method to assess ventilation may aid in management of children with acute asthma. The purpose of this study was to evaluate the association between end-tidal carbon dioxide (EtCO 2 ) values and disease severity among children with acute asthma.Methods: This was a prospective, blinded, observational study of children 3-17 years old treated for acute asthma in a pediatric emergency department (ED). EtCO 2 measurements were taken before the initiation of therapy and after each nebulization treatment (maximum of three). Peak expiratory flow rate (PEFR), Pediatric Asthma Severity Score (PASS), oxygen saturation, and disposition were recorded. Treating physicians, unaware of the EtCO 2 results, made all treatment decisions, including disposition.Results: One hundred children were enrolled. The mean initial EtCO 2 value was 35 mm Hg (95% confidence interval = 34.3 to 36

show abstract

A Prospective Multicenter Study of Patient Factors Associated With Hospital Admission From the Emergency Department Among Children With Acute Asthma

Abstract: Hospitalization for asthma exacerbation in children is primarily associated with clinical indicators in the ED and with historical factors such as previous asthma admission or intubation, recent use of corticosteroids, and comorbidity.

Cited by 71 publications

References 31 publications

Multicenter Analysis of Quality Indicators for Children Treated in the Emergency Department for Asthma

Multicenter Analysis of Quality Indicators for Children Treated in the Emergency Department for Asthma

Improving Pediatric Asthma Care Through Surveillance: The Illinois Emergency Department Asthma Collaborative

End-tidal Carbon Dioxide Measurements in Children with Acute Asthma

Contact Info

Product

Resources

About