General Emergency Department Management of Pediatric Asthma Exacerbations: The Impact of Pediatric Readiness on Guideline-Concordant Care
Abstract
Objective: To assess guideline-concordant management of children with moderate to severe asthma exacerbations in general emergency departments (EDs) and whether pediatric readiness is associated with receipt of guideline-concordant care.Methods: Retrospective cohort study of children 4-18 years treated at a general ED for asthma exacerbations and transferred and admitted to a pediatric tertiary care hospital health system. Children with complex medical conditions and those discharged from the pediatric tertiary hospital ED after transfer were excluded. General ED weighted Pediatric Readiness Scores (wPRS, range 0-100) obtained from the Colorado Emergency Medical Services for Children 2020 National Pediatric Readiness Project (NPRP) assessment were categorized by quartiles or deemed as no score if wPRS was unavailable (i.e., hospitals that had not completed the NPRP assessment or transfers from general EDs outside of Colorado). The primary outcome was receipt of asthma care in accordance with international guidelines defined as receipt of systemic corticosteroids and inhaled albuterol and ipratropium bromide. Secondary outcomes included clinical outcomes at the pediatric tertiary hospital (i.e., intensive care unit (ICU) admission, hospital length of stay). Multivariable logistic regression tested the association between wPRS and receipt of guideline-concordant asthma care, adjusting for demographics.Results: There were 319 general ED visits from 87 EDs across 4 states for…
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