Interventions for educating children who have attended the emergency room for asthma.
BACKGROUND
Asthma is one of the most common reasons for paediatric admissions to hospital, with substantial cost to the community. There is some evidence to suggest that many hospital admissions could be prevented with effective education about asthma and its management.


OBJECTIVE
To conduct a systematic review of the literature in order to identify whether asthma education leads to improved health outcomes in children who have attended the emergency department for asthma.


METHODS
We searched the Cochrane Airways Group trials register, including Medline, Embase, and Cinahl databases, and reference lists of trials and review articles.


METHODS
Randomised controlled trials or controlled clinical trials of asthma education for children who had attended the emergency department for asthma, with or without hospitalisation, within the previous 12 months.


METHODS
Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information.


RESULTS
Eight trials involving 1407 patients were included, in all the education was provided by nurses or researchers. Compared to control (usual care or lower intensity education) education did not reduce subsequent emergency department (ED) visits [4 trials; relative risk (RR)= 0.87, 95% confidence interval (CI) 0.37 to 2.08], hospital admissions [5 trials; RR=0.74, 95% CI 0.38 to 1.46] and unscheduled doctor visits [5 trials; RR= 0.74, 95% CI 0.49 to 1.12). Each analysis showed evidence of heterogeneity among the studies (P<0.01). Subgroup analyses by the overall difference in scale of intervention between treatment and control groups (comprehensive programme versus information only) or the timing of the intervention/recruitment (early versus delayed) gave similar results to the main analysis and still revealed significant heterogeneity between trials.


CONCLUSIONS
On the basis of the published trials, there is no firm evidence to support the use of asthma education for children who have attended the emergency department for asthma as a means of reducing subsequent ED visits, hospital admissions or unscheduled doctor visits. Some trials appeared to show clear evidence of benefit, but reasons for differences between these and the negative studies is not clear. More research is required
Haby
M M
MM
Centre for Community Child Health, Royal Children's Hospital, Flemington Rd, Parkville, Victoria, Australia, 3052. habym@cryptic.rch.unimelb.edu.au
Waters
E
E
Robertson
C F
CF
Gibson
P G
PG
Ducharme
F M
FM
D001249:Asthma / Q000517:prevention & control*; D002648:Child; D002986:Clinical Trials as Topic; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006760:Hospitalization; D006801:Humans; D010353:Patient Education as Topic