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Practice Pattern Variation in the Care of Children With Acute Asthma
Author(s) -
Chamberlain James M.,
Teach Stephen J.,
Hayes Katie L.,
Badolato Gia,
Goyal Monika K.
Publication year - 2016
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.12857
Subject(s) - medicine , asthma , emergency department , odds ratio , logistic regression , confidence interval , triage , pediatrics , emergency medicine , psychiatry
Objectives Pediatric asthma is a highly prevalent disease, affecting over 7 million U.S. children and accounting for 750,000 annual emergency department ( ED ) visits. Guidelines from the National Asthma Education and Prevention Program recommend limited use of chest radiography ( CXR ), complete blood counts ( CBC s), and antibiotics when managing acute exacerbations of asthma. However, studies suggest frequent overutilization of these resources. The objective was to evaluate differences between pediatric and general ED s in rates of CXR s, CBC s, and use of antibiotics for pediatric asthma exacerbations. Methods This was a repeated cross‐sectional analysis of data from the National Hospital Ambulatory Medical Care Survey from 2000 through 2010 of CXR , CBC s, and antibiotics during ED visits for pediatric acute asthma exacerbations. Multivariable logistic regression was performed to identify differences in asthma management by ED type (pediatric vs. general) after adjusting for demographic covariates. Results There were 3,313 observations, representing an estimated 10.9 million (95% confidence interval [ CI ] = 9.7 to 12.1 million) ED visits for acute asthma without bacterial coinfection. Of these, 17.4% occurred in pediatric ED s. Multivariable logistic regression revealed that visits to pediatric ED s were less likely to include CXR s (adjusted odds ratio [ AOR ] = 0.39; 95% CI = 0.25 to 0.60), CBC s ( AOR = 0.42; 95% CI = 0.22 to 0.80), and antibiotics ( AOR = 0.50; 95% CI = 0.31 to 0.82) after adjustment for race/ethnicity, triage level, academic ED , metropolitan statistical area, and geographic region. Conclusions There are substantial differences in diagnostic testing and antibiotic usage for management of acute exacerbations of asthma by ED type, suggesting potential resource overuse in general ED s. Future studies should focus on evaluating the effect of quality improvement efforts for ED asthma management.