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Benchmarks for the Emergency Department Care of Children With Asthma, Bronchiolitis, and Croup

Knapp, Jane F. MD*; Hall, Matthew PhD; Sharma, Vidya MBBS, MPH*

doi: 10.1097/PEC.0b013e3181db2262
Original Articles

Objectives: The objectives of this study were (1) to measure the 2005 performance of freestanding children's hospital emergency departments (EDs) in the care of children with asthma, bronchiolitis, and croup (ABC) using 5 clinical quality indicators and (2) to construct achievable benchmarks for 7 clinical quality indicators of ED care for children with ABC for 2005.

Methods: This was a retrospective review using the Pediatric Health Information System database containing information on 1,468,607 (2005) discharges. Performance on 5 established clinical quality indicators for ABC was determined in patients younger than 19 years at 27 hospital EDs in the United States. Benchmarks were computed for 7 clinical quality indicators.

Results: Corticosteroids were administered in 65.8% (95% confidence interval [CI], 65.2%-66.2%) of visits for moderate to severe asthma and in 82.5% (95% CI, 82.0%-83.0%) of visits for croup. Physicians ordered an x-ray in 28.6% (95% CI, 28.1%-29.0%) of asthma visits, 37.3% (95% CI, 36.7%-37.9%) of bronchiolitis visits, and in 9.1% (95% CI, 8.7%-9.5%) of croup visits. Benchmarks for corticosteroid administration were 79% and 92% for asthma and croup, respectively; benchmarks for ordering x-rays were 17% for both asthma and bronchiolitis and 2% for croup. Additional benchmarks for antibiotic administration in the ED for asthma and bronchiolitis were 1% and 2%, respectively.

Conclusions: Variation exists among freestanding children's hospitals in the ED care for ABC, but the performance is better than previously reported national averages. We report achievable benchmarks for ED care based on objective clinical quality indicators.

From the *Children's Mercy Hospitals and Clinics, The University of Missouri-Kansas City School of Medicine, Kansas City, MO; and †Child Health Corporation of America, Shawnee Mission, KS.

Reprints: Jane F. Knapp, MD, Office of Graduate Medical Education, Children's Mercy Hospitals and Clinics, 2401 Gillham Rd, Kansas City, MO 64108 (e-mail:

The authors have no disclosures.

© 2010 Lippincott Williams & Wilkins, Inc.