Effect of a clinical pathway on the hospitalisation rates of children with asthma: a prospective study
| Autor: | Bruce Carleton, Seamus P Norton, Fatma Taha, Martin V. Pusic, Susan Heathcote |
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| Rok vydání: | 2007 |
| Předmět: |
Male
medicine.medical_specialty Pediatrics Adolescent Tertiary care law.invention Clinical pathway Randomized controlled trial Adrenal Cortex Hormones law Internal medicine Acute care Administration Inhalation medicine Humans Prospective Studies Child Prospective cohort study Asthma Evidence-Based Medicine business.industry Infant Evidence-based medicine medicine.disease Bronchodilator Agents Hospitalization Child Preschool Acute Disease Practice Guidelines as Topic Pediatrics Perinatology and Child Health Critical Pathways Number needed to treat Original Article Female Emergency Service Hospital business |
| Zdroj: | Archives of Disease in Childhood. 92:60-66 |
| ISSN: | 1468-2044 0003-9888 |
| Popis: | Aim: To determine the effect of implementing a clinical pathway, using evidence-based clinical practice guidelines, for the emergency care of children and adolescents with asthma. Methods: A prospective, before–after, controlled trial was conducted, which included patients aged 1–18 years who had acute exacerbations of asthma treated in a tertiary care paediatric emergency department. Data were collected for identical 2-month seasonal periods before and after implementation of the clinical pathway to determine hospitalisation rate and other outcomes. For 2 weeks after emergency visits, the rate at which patients returned to emergency care for worsening asthma was evaluated. A multidisciplinary panel, using national guidelines and a systematic review, developed the pathway. Results: 267 patients were studied. The rate of hospitalisation was significantly lower in the post-implementation group (10/74; 13.5%) than in the pre-implementation control group (53/193; 27.5%; p = 0.02; number needed to treat 7.1). All reduction in hospitalisation occurred in children with moderate to severe asthma exacerbation. After implementation of the clinical pathway, the rate of administration of oral corticosteroids to patients with moderate or severe exacerbations increased from 71% to 92% (p = 0.01), and significantly more patients received β 2 -agonists in the first hour (p = 0.02). No significant change in relapse to acute care occurred within 2 weeks (p = 0.19). Conclusions: An evidence-based clinical pathway for children and adolescents with moderate to severe exacerbations of acute asthma markedly decreases their rate of hospitalisation without increased return to emergency care. |
| Databáze: | OpenAIRE |
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