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

Abstract:

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.

journal_name

Pediatr Emerg Care

journal_title

Pediatric emergency care

authors

Hudgins JD,Neuman MI,Monuteaux MC,Porter J,Nelson KA

doi

10.1097/PEC.0000000000001706

subject

Has Abstract

pub_date

2019-01-07 00:00:00

eissn

0749-5161

issn

1535-1815

pub_type

杂志文章
  • Is Serum Bicarbonate Level Associated With Negative Outcomes in Pediatric Patients?: A Retrospective Cohort Study.

    abstract:OBJECTIVES:Early identification of children at risk for adverse outcomes is important. Serum bicarbonate is easily collected and widely available. We described the relationship between bicarbonate and adverse outcomes in children presenting to the emergency department (ED). METHODS:We conducted a retrospective cohort ...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000000937

    authors: Poonai N,Mainprize D,Travers C,Vivas LLY,Tryphonopoulos P,Sangha G,Arbeau R,Seabrook J,Miller M,Sarpal A,Lim R

    更新日期:2017-11-01 00:00:00

  • Ondansetron Prescription for Home Use in a Pediatric Emergency Department.

    abstract:OBJECTIVES:Ondansetron has been shown to decrease admission rate and the need for intravenous fluids among pediatric emergency department (ED) patients with acute gastroenteritis, but there is limited evidence regarding its use after ED discharge. This study describes prescribing patterns for ondansetron and assesses t...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000001343

    authors: Gray JM,Maewal JD,Lunos SA,Furnival RA,Hendrickson MA

    更新日期:2020-03-01 00:00:00

  • Presentation, evaluation, and treatment of clavicle fractures in preschool children presenting to an emergency department.

    abstract:UNLABELLED:Clavicle fractures are a common injury among pediatric patients. Few data exist regarding specific etiologies and their management in the preadolescent patient. Our objective was to determine the specific source of injury and treatment techniques used in the youngest patient population. METHODS:Study Design...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章,多中心研究

    doi:10.1097/PEC.0b013e3181bec7fc

    authors: Soto F,Fiesseler F,Morales J,Amato C

    更新日期:2009-11-01 00:00:00

  • Common pediatric fractures treated with minimal intervention.

    abstract::The unlikely event of long-term complications in some pediatric fractures, such as midclavicular fractures, has allowed for management of these injuries with interventions that support the injured extremity rather than immobilize it while healing occurs. However, there is currently a growing body of evidence that advo...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章,评审

    doi:10.1097/PEC.0b013e3181ce310c

    authors: Boutis K

    更新日期:2010-02-01 00:00:00

  • Elastic bands on the wrist: a not so "silly" complication.

    abstract::The recent popularity of elastic bands on the wrist may put children at risk for acute compartment syndrome. Acute compartment syndrome is a limb-threatening condition characterized by elevated interstitial pressure in a confined fascial compartment. If left untreated, it may result in tissue necrosis, irreversible ne...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0b013e318217b5a7

    authors: McIver MA,Gochman RF

    更新日期:2011-05-01 00:00:00

  • Chlamydia Conjunctivitis in 2 Prepubertal Children: An Uncommon Presentation of Child Sexual Abuse.

    abstract::Sexually transmitted infection as the result of child sexual abuse in prepubertal children is uncommon. Chlamydia trachomatis conjunctivitis is an even less common entity in prepubertal children outside the newborn period. This report details the presentation of 2 children with conjunctivitis who were subsequently dia...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000001449

    authors: Brownell AD,Miraldi Utz V,Makoroff KL,Shapiro RA,Mortensen JE

    更新日期:2020-08-01 00:00:00

  • Subcutaneous Granuloma Annulare: A Diagnostic Conundrum-Learning From Mistakes.

    abstract::Subcutaneous granuloma annulare is an inflammatory lesion occurring in otherwise healthy children. We present 3 pediatric patients with different diagnostic-therapeutic paths depending on the ward they were referred to. The lesions regress spontaneously, and medical or surgical treatments are generally not necessary. ...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000000591

    authors: Pederiva F,Paloni G,Berti I

    更新日期:2017-08-01 00:00:00

  • Anomalous Left Coronary Artery From the Pulmonary Artery in Infants and Toddlers Misdiagnosed as Myocarditis.

    abstract:OBJECTIVES:Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart defect. Children with this anomaly are usually asymptomatic at birth and develop symptoms later on in life, which may mimic myocarditis. We sought to delineate clinical, laboratory, and epidemiological aspects of thi...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000000511

    authors: Levitas A,Krymko H,Ioffe V,Zalzstein E,Broides A

    更新日期:2016-04-01 00:00:00

  • Intravenous Paracetamol Overdose: A Pediatric Case Report.

    abstract::Paracetamol is a common antipyretic often used to treat children with fever and pain. With the increasing administration of intravenous (IV) paracetamol, there will be the associated risk of medication dosing errors. We report a case of IV paracetamol overdose in a child with fever during hospital admission. A IV para...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000001432

    authors: Aslan N,Yildizdas D,Arslan D,Horoz OO,Yilmaz HL,Bilen S

    更新日期:2019-02-01 00:00:00

  • Pediatricians Support Initiation of Asthma Controller Medications in the Emergency Department: A National Survey.

    abstract:OBJECTIVES:Although National Asthma Guidelines recommend that emergency department (ED) physicians consider initiating controller medications, research suggests that this practice occurs infrequently. The goal of this study was to assess primary care pediatricians' (PCP) beliefs and attitudes regarding ED initiation of...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000000389

    authors: Sampayo EM,McLoughlin RJ,Tsevdos D,Alam S,Zorc JJ

    更新日期:2015-08-01 00:00:00

  • Improving Timeliness of β-Agonist and Corticosteroid Administration in Patients With Acute Wheezing.

    abstract:OBJECTIVE:Timely delivery of β-agonists and steroids to patients with acute recurrent wheezing is a key component of the National Heart, Lung, and Blood Institute recommended emergency department (ED) asthma care. We conducted an ED improvement initiative to standardize asthma care and improve time to treatments. METH...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000001249

    authors: McIver M,Stoudemire W,Smith-Ramsey C,Panigrahi M,Walsh-Kelly C,Rutman LE

    更新日期:2017-09-01 00:00:00

  • When a funduscopic examination is the clue of maltreatment diagnostic.

    abstract:OBJECTIVE:: To report a case of unexpected shaken baby syndrome, the diagnosis of which was possible after an incidental funduscopic examination. METHODS:: Observational case report. An infant was to be sent back home with an apparent unprovoked seizure diagnosis when a funduscopic examination was made because of an i...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/01.pec.0000227385.46143.20

    authors: Barcenilla AI,de la Maza VT,Cuevas NC,Ballús MM,Castanera AS,Fernández JP

    更新日期:2006-07-01 00:00:00

  • Acute disseminated encephalomyelitis: an unusual cause of encephalitic syndrome in childhood.

    abstract::Acute disseminated encephalomyelitis is a rare central nervous system demyelinating disease that occurs most frequently in children. It usually runs a monophasic course, beginning with fever, headache, and meningeal signs and rapidly progressing to coma when appropriate diagnosis and treatment are not provided. We rep...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:

    authors: Sztajnbok J,Lignani L Jr,Bresolin AU,Marotto PC,Seguro AC

    更新日期:1998-02-01 00:00:00

  • Teaching Point-of-Care Lung Ultrasound to Novice Pediatric Learners: Web-Based E-Learning Versus Traditional Classroom Didactic.

    abstract:OBJECTIVE:To assess whether Web-based teaching is at least as effective as traditional classroom didactic in improving the proficiency of pediatric novice learners in the image acquisition and interpretation of pneumothorax and pleural effusion using point-of-care ultrasound (POCUS). METHODS:We conducted a randomized ...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000001482

    authors: Soon AW,Toney AG,Stidham T,Kendall J,Roosevelt G

    更新日期:2020-07-01 00:00:00

  • Deep vein thrombosis in an adolescent.

    abstract::We report an unusual case of deep vein thrombosis following minor trauma in an adolescent who presented with a swollen, tender, lower extremity. Work-up consisted of a venogram which demonstrated occlusion of the deep venous system in the proximal leg. The patient was hospitalized for intravenous heparin followed by o...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/00006565-198906000-00008

    authors: Berman DA,Norris RL,Crow T,Scatamacchia S

    更新日期:1989-06-01 00:00:00

  • Aeromedical Transport in Children: A Descriptive Analysis of 96 Cases.

    abstract:OBJECTIVE:Pediatric aeromedical transport (AT) is highly challenging. We aim to describe a series of 96 cases of children requiring medical transport in terms of the indication, modalities, and related adverse events. METHODS:In this single-center retrospective study, we included air-transported patients less than 18 ...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000001308

    authors: Mortamet G,Harrington K,Raffin H,Menat Y,Oualha M,Renolleau S

    更新日期:2020-01-01 00:00:00

  • A Knotted Urethral Catheter in the Emergency Department.

    abstract::Inadvertent knotting of urethral catheters and enteric feeding tubes is a rare complication in pediatric patients. If a small flexible tube is used and advanced too far, upon withdrawal, the catheter may knot in the bladder. Surgical intervention for retrieval is required in most cases. We present a case of a 26-day-o...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000000751

    authors: Terentiev V,Khentsinsky O,Dickman E,Cortis C,Arroyo A

    更新日期:2017-03-01 00:00:00

  • Current variability of clinical practice management of pediatric diabetic ketoacidosis in Illinois pediatric emergency departments.

    abstract:OBJECTIVE:This study aimed to investigate the management of pediatric patients with diabetic ketoacidosis (DKA) presenting to emergency departments (EDs) participating in the Illinois Emergency Medical Services for Children (EMSC) Facility Recognition program. METHODS:In 2010, Illinois EMSC conducted a survey (includi...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0b013e3182768bfc

    authors: Barrios EK,Hageman J,Lyons E,Janies K,Leonard D,Duck S,Fuchs S

    更新日期:2012-12-01 00:00:00

  • Pulmonary Embolism Mimicking Infectious Pleuritis.

    abstract::The diagnosis of pulmonary thromboembolism (PE) is often delayed because it is usually misdiagnosed as pneumonia or deep vein thrombosis. We report an unusual case of PE misdiagnosed as viral pleuritis on the first arrival at the emergency department (ED) in our hospital. A 14-year-old girl with no previous significan...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000001104

    authors: Tetsuhara K,Tsuji S,Uematsu S,Kamei K

    更新日期:2018-11-01 00:00:00

  • Epidemiology of Admissions From the Emergency Department Among Febrile Infants Younger Than 90 Days in the United States, 2002 to 2012.

    abstract:BACKGROUND AND OBJECTIVES:Febrile infants younger than 90 days are often subjected to invasive diagnostic evaluation and hospitalization to monitor for serious bacterial infection (SBI) despite recent changes in SBI risk and advances in diagnostics. Nationwide provider practices, over time, are unknown for this group. ...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000001262

    authors: Nguyen DK,Fleischman RJ,Friedlander S,Zangwill KM

    更新日期:2020-08-01 00:00:00

  • Pediatric Bilateral Facial Paralysis: An Unusual Presentation of Lyme Disease.

    abstract::Pediatric bilateral facial nerve paralysis (FNP) is a rare condition, representing less than 2% of all cases of FNP. The differential diagnosis of FNP is extensive (ranging from infectious, traumatic, neurologic, to idiopathic) and often can present as a diagnostic challenge. In contrast to unilateral presentation, bi...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000001648

    authors: Wong K,Sequeira S,Bechtel K

    更新日期:2020-11-01 00:00:00

  • A Rare Case of Candida Epiglottitis in an Immunocompetent Child.

    abstract::We present a case of acute Candida epiglottitis in an otherwise healthy and Haemophilus influenzae type B-immunized 4-year-old child. A query of the literature reveals this disease to be commonly found in patients who are immunocompromised by problems including human immunodeficiency virus disease and lymphoma and leu...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章,评审

    doi:10.1097/PEC.0000000000001082

    authors: Beil EP,Sole DP

    更新日期:2019-02-01 00:00:00

  • Invasive Yersiniosis in a Pediatric Patient With β-Thalassemia Major: Acute Decompensation After Rapid Blood Transfusion.

    abstract::Yersinia enterocolitica infection, or yersiniosis, is a common cause of gastroenteritis in developing nations, but the disease is less common in the developed world. Yersiniosis typically presents as a self-limited gastroenteritis in an immunocompetent patient and rarely progresses to the more fulminant disseminated f...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000001873

    authors: Hsu G,Jones A,Thornton B

    更新日期:2019-07-01 00:00:00

  • Baclofen overdose in two siblings.

    abstract::Baclofen is a muscle relaxant used in both adults and children with neuromuscular disorders to control spasticity. In children, relatively few cases of overdose have been previously reported. We report two cases of baclofen overdose occurring in two siblings. One sibling with cerebral palsy was being treated with bacl...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章,评审

    doi:10.1097/00006565-200104000-00008

    authors: Chapple D,Johnson D,Connors R

    更新日期:2001-04-01 00:00:00

  • Smoke inhalation and carbon monoxide poisoning in children.

    abstract::This article reviews the mechanisms of pulmonary injury associated with smoke inhalation and the pathophysiology of carbon monoxide poisoning. In addition, the temporal stages of pulmonary injury and evaluation and treatment of the pediatric patient are discussed. Maintaining a high index of suspicion when treating th...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/00006565-198603000-00010

    authors: Parish RA

    更新日期:1986-03-01 00:00:00

  • Torsade de pointes associated with Astemizole overdose treated with magnesium sulfate.

    abstract::Astemizole (Hismanal-Janssen, New Brunswick, NJ) is a nonsedating antihistamine that has the advantage of a once-daily dosage schedule. This article reports the case of a 14-year-old female who intentionally ingested 270 mg of Astemizole and developed torsade de pointes, a form of polymorphic ventricular tachycardia t...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/00006565-199302000-00008

    authors: Hasan RA,Zureikat GY,Nolan BM

    更新日期:1993-02-01 00:00:00

  • Case report of metallic mercury injury.

    abstract:OBJECTIVE:Injury and poisoning from metallic mercury has become a rare event. Review of the literature and a case report of pediatric metallic mercury injury are presented. DESIGN:A case report. SETTING:The Emergency Department at St. Louis Children's Hospital. PATIENTS OR PARTICIPANTS:A 15-year-old boy. INTERVENTI...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章,评审

    doi:10.1097/00006565-199704000-00008

    authors: Smith SR,Jaffe DM,Skinner MA

    更新日期:1997-04-01 00:00:00

  • Incidental renal mass found on focused assessment with sonography in trauma.

    abstract::We present the case of a 9-year-old female who presented after minor blunt abdominal trauma during a sporting event. On focused assessment with sonography for trauma, she was found to have an incidental renal mass, which was ultimately diagnosed as a renal cell carcinoma. In this report, we focus on the use of bedside...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000000242

    authors: Dunlop JH,Cohen JS

    更新日期:2014-10-01 00:00:00

  • A Descriptive Analysis of Pediatric Prehospital Refusal of Medical Assistance Within a Single Service Provider System.

    abstract:OBJECTIVES:Pediatric refusal of medical assistance (RMA) is a potentially high-risk event with implications for both individual patient outcomes and greater emergency medical services system efficiency. The purpose of this study was to describe characteristics of pediatric RMA calls and outcomes. METHODS:Single emerge...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000002018

    authors: Mix FM,Myers LA,Luke A,Sztajnkrycer MD

    更新日期:2020-01-01 00:00:00

  • Effect of a research nurse on patient enrollment in a clinical study.

    abstract:OBJECTIVES:To assess the effect of adding a shared research nurse on patient enrollment in an ongoing clinical study. DESIGN:Before/after comparison of recruitment rates and consent rates involving patients eligible for a study of blood culture collection strategies for methods on the detection of bacteremia and deter...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/00006565-199610000-00004

    authors: Isaacman DJ,Reynolds EA

    更新日期:1996-10-01 00:00:00