Reassessment of asthma management in an accident and emergency department

Chidley, K.E.; Wood‐Baker, Richard; Town, GI; Sleet, R. A.; Holgate, Stephen T.

doi:10.1016/s0954-6111(06)80180-0

Cited by 25 publications

(7 citation statements)

References 15 publications

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“…Other audits have also found the recording of clinical data to be suboptimal, [12][13][14][15][16][17] but few have focused on children. In 1989, O'Halloran and Heaf reported that a PEFR was recorded for 35% of children presenting at A&E. 17 Our results suggest that there has been little improvement in the assessment of children with asthma since then despite the introduction of national guidelines.…”

Section: Discussionmentioning

confidence: 99%

Accident and emergency departments are still failing to assess asthma severity

Harvey

Forbes

Jarvis

et al. 2003

Emergency Medicine Journal

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Objectives: To quantify the documentation of vital signs in children attending accident and emergency (A&E) for asthma and to assess whether indicators of severity were used appropriately. Methods: Records of all children aged 3 to 14 attending A&E for the treatment of asthma in four London hospitals over a three month period were examined for documentation of heart rate, respiratory rate, peak expiratory flow rate, oxygen saturation, and fraction of inspired oxygen. The relation between severity indicators and whether the child was admitted or not was examined.Results: There were 255 attendances in 229 children. Heart rate, respiratory rate, and oxygen saturation were recorded on most attendances (94.5%, 85.5%, and 96.8%) but fraction of inspired oxygen and peak flow were recorded in few children (48.6% and 48.5%). Heart rate and respiratory rate were higher and oxygen saturation lower in children who were admitted compared with those who were not. Conclusions: Assessment of airways obstruction is inadequate in children but when measured may be used appropriately to guide admission. There is a need for interventions to improve assessment of children attending A&E for asthma. F ailure to assess adequately the severity of asthma attacks is regarded as one of the factors contributing to asthma deaths. [1][2][3] In recognition of this, national UK guidelines emphasise the importance of objective assessment of asthma severity.4 5 They recommend that heart rate, respiratory rate, and oxygen saturation (SaO 2 ) are measured in everyone presenting with an acute attack, and that peak expiratory flow rate (PEFR) is measured in everyone over the age of 5 years. They give specific cut off points for identifying people who should be admitted to hospital. These are based on evidence that abnormalities of these indicators are associated with re-presentation for medical care and need for intravenous treatment.6-10 They are also likely to be associated with risk of respiratory failure.Although the guidelines offer a widely accepted standard of care for people with asthma, some evidence suggests that the inadequate assessment identified by several confidential inquiries persists.1-3 Pinnock et al examined the management of asthma by primary and secondary care within a UK health district and found assessment of PEFR to be incomplete. 11PEFR was recorded in 76% of patients aged 6 years and over but, of those given a bronchodilator, only 42% had a PEFR recorded before and after treatment to assess its effectiveness. The investigators, however, did not look at differences in the care of children and adults, an issue that was highlighted by an American study of documented asthma care in the emergency room.12 In this study, PEFR was ordered on 31% of children compared with 64% of adult patients presenting with acute asthma. Despite the availability of widely accepted guidelines and the high incidence of accident and emergency (A&E) attendances for asthma, there are no recent studies in the UK that examine the quality of care in A&E sp...

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Section: Discussionmentioning

confidence: 99%

Accident and emergency departments are still failing to assess asthma severity

Harvey

Forbes

Jarvis

et al. 2003

Emergency Medicine Journal

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“…16 Our findings on timing of symptoms were generally comparable to results reported elsewhere, [17][18][19] although observations have been variable for asthma ED visits. 13,14,[20][21][22] These findings, together with evidence from studies which find the strongest association between air pollution and hospital admissions with a lag of 0-2 days prior to the visit, 3,4 suggest that in many cases air pollution acts as an exacer-bator of a condition which has often already been precipitated by some other factor.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding use of medications by asthmatics prior to their visit, compared to most earlier reports, use of ß-agonists, methylxanthines and oral steroids was less frequent in our study, while use of inhaled steroids and anticholinergics was similar or more frequent. [5][6][7]9,14,[20][21][22] We found greater use of oral steroids (17.8%), anticholinergics (24.7%), and methylxanthines (9.6%) among those whose past asthma history was rated as severe. While inhaled steroid use was also more prevalent in this group (60.3%), current treatment guidelines suggest that it should be higher.…”

Section: Discussionmentioning

confidence: 99%

Beyond Administrative Data: Characterizing Cardiorespiratory Disease Episodes Among Patients Visiting the Emergency Department

Stieb¹,

Beveridge

Smith‐Doiron

et al. 2000

Can J Public Health

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“…1,2 Exacerbations of asthma may be indicative of underestimation of the background severity of asthma, delay in initiation of rescue therapy, and inappropriate treatment that includes over-reliance on bronchodilators and under-use of preventers. Studies conducted worldwide on the management of asthma in EDs have highlighted deficiencies such as inadequate assessment of asthma, [3][4][5][6][7] failure to provide adequate treatment in ED, [4][5][6][8][9][10][11] and inadequacy of follow-up arrangements from ED. 5,6,12 Conversely, most asthma is episodic.…”

mentioning

confidence: 99%