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Provision of Guideline-Based Pediatric Asthma Care in US Emergency Departments

Hudgins, Joel D. MD; Neuman, Mark I. MD, MPH; Monuteaux, Michael C. ScD; Porter, John MBA; Nelson, Kyle A. MD, MPH

doi: 10.1097/PEC.0000000000001706
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Objectives National guidelines for routine pediatric acute asthma care recommend providing corticosteroids, and discourage routinely obtaining chest radiographs (CXRs) and using antibiotics. We examined rates of adherence to all 3 of these aspects during emergency department (ED) visits and compared performance between pediatric and general EDs.

Methods Using the National Hospital Ambulatory Medical Care Survey, we included all nontransfer ED visits for patients younger than 19 years with a diagnosis of asthma and treatment with albuterol from 2005 to 2015. Guideline-based care, defined as (1) corticosteroids, (2) no antibiotics, and (3) no CXR, was assessed for each visit. Hospitals were categorized as pediatric or general and compared according to rates of guideline-based care. Multivariable analyses were used to identify demographic and hospital-level characteristics associated with guideline-based care.

Results More than 7 million ED visits met eligibility criteria. Antibiotic provision and CXR acquisition were significantly higher in general EDs (20% vs 11%, 40% vs 26%, respectively), while steroid provision was similar (63% vs 62%). Overall, 34% of visits involved guideline-based care, with a higher rate for pediatric EDs compared with general EDs (42% to 31%). Visit at a pediatric ED (odds ratio, 1.62 [confidence interval 1.17–2.25]) and black race (odds ratio, 1.48 [confidence interval 1.07–2.02]) were independently associated with guideline-based care in a multivariate analysis.

Conclusions Guideline-based care was more common in pediatric EDs, although only one-third of all pediatric-age visits met the definition of guideline-based care. Future policy and education efforts to reduce unnecessary antibiotic and CXR use for children with asthma are warranted.

From the Division of Emergency Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA.

Disclosure: The authors declare no conflict of interest.

Reprints: Joel D. Hudgins, MD, Division of Emergency Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115 (e-mail: Joel.hudgins@childrens.harvard.edu).

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