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首页> 外文期刊>The journal of asthma >Clinical pathway improves pediatrics asthma management in the emergency department and reduces admissions
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Clinical pathway improves pediatrics asthma management in the emergency department and reduces admissions

机译:临床途径改善了急诊科的儿科哮喘管理并减少了入院率

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摘要

Objective: Poor adherence to the National Institute of Health (NIH) Asthma Guidelines may result in unnecessary admissions for children presenting to the emergency department (ED) with exacerbations. We determine the effect of implementing an evidence-based ED clinical pathway on corticosteroid and bronchodilator administration and imaging utilization, and the subsequent effect on hospital admissions in a US ED. Methods: A prospective, interventional study of pediatric (<= 21 years) visits to an academic ED between 2011 and 2013 with moderate-severe asthma exacerbations has been conducted. A multidisciplinary team designed a one-page clinical pathway based on the NIH Guidelines. Nurses, respiratory therapists and physicians attended educational sessions prior to the pathway implementation. By adjusting for demographics, acuity and ED volume, we compared timing and appropriateness of corticosteroid and bronchodilator administration, and chest radiograph (CXR) utilization with historical controls from 2006 to 2011. Subsequent hospital admission rates were also compared. Results: A total of 379 post-intervention visits were compared with 870 controls. Corticosteroids were more likely to be administered during post-intervention visits (96% vs. 78%, adjusted OR 6.35; 95% CI 3.17-12.73). Post-intervention, median time to corticosteroid administration was 45 min faster (RR 0.74; 95% CI 0.67-0.81) and more patients received corticosteroids within 1 h of arrival (45% vs. 18%, OR 3.5; 95% CI 2.50-4.90). More patients received >1 bronchodilator dose within 1 h (36% vs. 24%, OR 1.65; 95% CI 1.23-2.21) and fewer received CXRs (27% vs. 42%, OR 0.7; 95% CI 0.52-0.94). There were fewer admissions post-intervention (13% vs. 21%, OR 0.53; 95% CI 0.37-0.76). Conclusion: A clinical pathway is associated with improved adherence to NIH Guidelines and, subsequently, fewer hospital admissions for pediatric ED patients with asthma exacerbations.
机译:目的:对美国国家卫生研究院(NIH)哮喘指南的依从性差可能会导致急诊(ED)病情加重的儿童不必要的入院。我们确定了在皮质类固醇和支气管扩张剂的给药和影像学应用方面实施循证医学教育临床途径的效果,以及在美国医学教育中对入院的后续影响。方法:对2011年至2013年间中度重度哮喘加重的儿童急诊科(<= 21岁)进行了前瞻性干预研究。一个多学科团队根据《 NIH指南》设计了一页的临床路径。在实施该途径之前,护士,呼吸治疗师和医师参加了教育会议。通过调整人口统计学,敏锐度和ED量,我们比较了皮质类固醇和支气管扩张剂的给药时间和适当性,并比较了2006年至2011年的胸部X光片(CXR)使用率与历史对照。还比较了其随后的住院率。结果:总共进行了379次干预后访视,与870名对照进行了比较。干预后访视期间更可能使用皮质类固醇(96%比78%,调整后的OR为6.35; 95%CI为3.17-12.73)。干预后,皮质类固醇给药的中位时间缩短了45分钟(RR 0.74; 95%CI 0.67-0.81),并且更多患者在到达后1小时内接受了皮质类固醇治疗(45%比18%,OR 3.5; 95%CI 2.50- 4.90)。更多的患者在1小时内接受了大于1的支气管扩张剂剂量(36%比24%,或1.65; 95%CI 1.23-2.21),更少接受CXR(27%比42%,OR 0.7; 95%CI 0.52-0.94) 。干预后的入院人数较少(13%比21%,或0.53; 95%CI 0.37-0.76)。结论:临床途径与改善对NIH指南的依从性相关,因此,小儿ED哮喘加重患者的入院次数减少。

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