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Acute Obstructive Respiratory Tract Diseases in a Pediatric Emergency Unit: Evidence-Based Evaluation

Kilic, Ayse MD*†; Ünüvar, Emin MD*†; Sütçü, Murat MD; Süleyman, Ayşe MD; Tamay, Zeynep MD§; Yildiz, İsmail MD*; Oguz, Fatma MD∥˘; Sidal, Müjgan MD; Güler, Nermin MD§

doi: 10.1097/PEC.0b013e3182768d17
Original Articles

Objectives The objective of this study was to determine the evidence-based performance of the pediatric emergency unit in the diagnosis of and treatment approach to the patients with asthma, bronchiolitis, and croup.

Methods In this study conducted in a retrospective cross-sectional way, emergency cards and computer data have been used. In the performance evaluation, the National Hospital Ambulatory Medical Care Survey criteria were considered. In the evaluation of performance in diagnosis, the rates of chest x-ray studies and use of corticosteroids and antibiotics were examined. Use of antibiotics in the cases not having a fever or any symptoms of bacterial infection and failure in prescribing steroids to the cases with moderate-to-severe symptoms were considered as bad performance criteria. χ2 test was used for the data, which can be classified; Mann-Whitney U and Student t tests were used for the data with normal distribution and for the continuous variables.

Results Study groups were composed of 2795 patients (1742 cases with asthma, 115 cases with croup, 938 cases with bronchiolitis) aged between 3 and 140 months (mean [SD], 41.2 [31] months). Chest x-ray study was requested significantly more often in the cases of bronchiolitis and croup with severe symptoms. In asthma cases, chest x-ray study was requested in those with severe clinical symptoms. In all 3 groups, a significant difference between the severity levels of the cases, from whom hemogram was requested, was determined. Biochemical tests were requested more often in those with severe bronchiolitis or asthma. Antibiotics were prescribed to none of the mild bronchiolitis cases. However, steroids were recommended more often to patients with moderate and severe bronchiolitis. They were administered to all patients with croup. Systemic steroids were prescribed more often to those with moderate or severe asthma.

Conclusions In our unit, both antibiotics administration and chest x-ray studies requested in patients with bronchiolitis, croup, and asthma were in low rates. Steroids in asthma attacks were found to be high in severe cases and in croup cases as well.

From the Divisions of *Ambulatory Pediatrics, and †Pediatric Emergency Medicine, ‡Department of Pediatrics, §Division of Pediatric Allergy and Immunology, ∥Institute of Child Health, Divisions of Ambulatory Pediatrics and Pediatric Emergency Medicine, Department of Pediatrics, and ¶Institute of Child Health, Division of Pediatric Infectious Diseases, University of Istanbul, Istanbul, Turkey.

Disclosure: The authors declare no conflict of interest.

Reprints: Ayse Kiliç MD, İstanbul Tıp Fakültesi, Çocuk Klinig˘i, Çapa 34390, Fatih İstanbul, Turkey (e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.