ABSTRACT
OBJECTIVE: To describe and compare the treatment of acute asthma exacerbations in children given in the emergency department (ED) and admitted to acute care floor in the hospital or intensive care unit (ICU). METHODS: A retrospective chart review of visits for acute exacerbation of asthma treated at Phoenix Children's Hospital between January 1, 2014 and December 31, 2016. RESULTS: A total of 287 asthma exacerbation cases were identified including 106 (37%) ED visits, 134 (47%) hospital floor and 47 (16%) ICU admissions. A history of a previous ED visit (ED 88%, Floor 60% and ICU 68%; p < 0.0001) and prior pulmonology inpatient consultation (ED 30%, Floor 19% and ICU 15%; p = 0.05) varied significantly. Pulmonology inpatient consultations were performed more frequently in the ICU than on the hospital floor (54% versus 8%; p < 0.0001). Although overall 145 (51%) of the cases were already on inhaled corticosteroids (ICS) at the time of visit with no differences across locations, ICS initiation/step-up was greater in the ICU (72%) than on the hospital floor (54%) and ED (2%) (p < 0.0001). A recommendation given to the family for follow-up with pulmonology was more frequent for patients who had been admitted to the ICU (68%) as compared to those only admitted to the floor (31%) or ED (4%) (p < 0.0001). Readmission rates were similar for patients previously admitted to the hospital (Floor 42%; ICU 40%), but significantly higher for previous ED visits (77%) (p < 0.0001). CONCLUSIONS: Physicians in the ED have an opportunity to provide preventative care in the acute care setting and should be encouraged to initiate treatment with ICS. Consideration should be given to develop a program or clinical pathway focused on long-term asthma management and maintenance to reduce readmissions and long hospital stays.
Subject(s)
Asthma/drug therapy , Critical Pathways/statistics & numerical data , Emergency Service, Hospital/statistics & numerical data , Intensive Care Units/statistics & numerical data , Outcome and Process Assessment, Health Care/statistics & numerical data , Administration, Inhalation , Adolescent , Anti-Asthmatic Agents/therapeutic use , Child , Critical Pathways/organization & administration , Critical Pathways/standards , Emergency Service, Hospital/organization & administration , Emergency Service, Hospital/standards , Female , Glucocorticoids/therapeutic use , Humans , Intensive Care Units/organization & administration , Intensive Care Units/standards , Male , Practice Guidelines as Topic , Quality Improvement , Retrospective StudiesABSTRACT
OBJECTIVE: To investigate the safety and efficacy of a dopamine agonist, amantadine hydrochloride (AMH), in the treatment of neurobehavioral sequelae of pediatric TBI. PROCEDURES: Age- and severity-matched traumatic brain injury groups, randomized to AMH (n = 17) or usual care (n = 10), completed behavior scales and neuropsychological tests. Effect sizes measured the treatment effect within subjects and between groups. Side effects were tracked over the 12-week study course. RESULTS: Behavior improved in the AMH group, but only those 2 years or fewer postinjury showed a treatment effect on cognitive tests. CONCLUSIONS: After traumatic brain injury, a 12-week course of AMH was safe and, according to parent report, improved behavior. AMH may have the potential to improve cognition in more recently injured children.