PEDIATRICS Vol. 107 No. 6 June 2001, pp. 1357-1362
Short-Term Outcomes After Acute Treatment of Pediatric Asthma
Received Mar 3, 2000; accepted Nov 1, 2000.
, §
From the * Department of Pediatrics, Division of Emergency
Medicine, The Children's Hospital of Philadelphia, Philadelphia,
Pennsylvania; the Context. The short-term course of
pediatric patients after emergency department (ED) treatment for acute
asthma has not been comprehensively documented; most previous studies
have limited outcomes to ED length-of-stay, hospital admission, and
relapse.
Objective. To describe symptom persistence, medication
use, functional disability, follow-up, and relapse in these children in
the 2 weeks after acute treatment and ED discharge.
Design. Randomly selected, prospective cohort from
September 1996 to August 1997; follow-up telephone interviews at 1 and
2 weeks.
Setting. A large, inner-city children's hospital
emergency department.
Patients. Random sample of pediatric asthma visits
requiring ED treatment but not admission; 457 were eligible, 388 with
complete follow-up (85%); final sample included 367 patients after
multiple visits deleted.
Main Outcome Measures. Details of symptom persistence,
functional disability, medication use, relapse, and routine
follow-up.
Results. Results included significant morbidity: 23%
(95% confidence interval [CI]: 19, 27) with cough and 12% (95% CI:
9, 15) with wheeze persistent at 2 weeks; 20% (95% CI: 16, 24) with
decreased activity at 1 week; 45% (95% CI: 39, 51) missed >2 and
24% (95% CI: 19, 29) Conclusions. A considerable proportion of inner-city
pediatric patients discharged from the hospital from the ED after
standard treatment for acute asthma had poor short-term outcomes.
Conventional markers of successful ED treatment, such as
avoiding hospital admission or relapse, do not adequately describe
outcomes of acute care. The patient-oriented measures described here
may provide more useful indicators of outcome in the evaluation of
acute asthma care.
Center for Clinical Epidemiology and
Biostatistics, University of Pennsylvania School of Medicine,
Philadelphia, Pennsylvania; and the § Department of Pediatrics,
Division of Emergency Medicine, A.I. duPont Hospital for Children,
Wilmington, Delaware.
5 days of school or day care; 17% (95% CI:
13, 21) spent 3 days in bed; 54% (95% CI: 47, 60) of caretakers
missed at least 1 and 18% (95% CI: 13, 24) missed >2 days of school
or work; and 32% (95% CI: 28, 38) of patients were still using
greater than baseline medication at 2 weeks. Reported relapse rates
were averaged at 13% (95% CI: 10, 17) with 3% (95% CI: 1, 5)
admitted. Routine office follow-up was poor: 29% (95% CI: 25, 34) had
had a visit; 48% (95% CI: 43, 54) reported no visit/none
planned.
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