Short-term outcomes after acute treatment of pediatric asthma.
BACKGROUND
The short-term course of pediatric patients after emergency department (ED) treatment for acute asthma has not been comprehensively documented; most previous studies have limited outcomes to ED length-of-stay, hospital admission, and relapse.


OBJECTIVE
To describe symptom persistence, medication use, functional disability, follow-up, and relapse in these children in the 2 weeks after acute treatment and ED discharge.


METHODS
Randomly selected, prospective cohort from September 1996 to August 1997; follow-up telephone interviews at 1 and 2 weeks. Setting. A large, inner-city children's hospital emergency department. Patients. Random sample of pediatric asthma visits requiring ED treatment but not admission; 457 were eligible, 388 with complete follow-up (85%); final sample included 367 patients after multiple visits deleted.


METHODS
Details of symptom persistence, functional disability, medication use, relapse, and routine follow-up.


RESULTS
Results included significant morbidity: 23% (95% confidence interval [CI]: 19, 27) with cough and 12% (95% CI: 9, 15) with wheeze persistent at 2 weeks; 20% (95% CI: 16, 24) with decreased activity at 1 week; 45% (95% CI: 39, 51) missed >2 and 24% (95% CI: 19, 29) >/=5 days of school or day care; 17% (95% CI: 13, 21) spent >/=3 days in bed; 54% (95% CI: 47, 60) of caretakers missed at least 1 and 18% (95% CI: 13, 24) missed >2 days of school or work; and 32% (95% CI: 28, 38) of patients were still using greater than baseline medication at 2 weeks. Reported relapse rates were averaged at 13% (95% CI: 10, 17) with 3% (95% CI: 1, 5) admitted. Routine office follow-up was poor: 29% (95% CI: 25, 34) had had a visit; 48% (95% CI: 43, 54) reported no visit/none planned.


CONCLUSIONS
A considerable proportion of inner-city pediatric patients discharged from the hospital from the ED after standard treatment for acute asthma had poor short-term outcomes. Conventional markers of successful ED treatment, such as avoiding hospital admission or relapse, do not adequately describe outcomes of acute care. The patient-oriented measures described here may provide more useful indicators of outcome in the evaluation of acute asthma care.
Stevens
M W
MW
Department of Pediatrics, Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. msteve@chmc.org
Gorelick
M H
MH
D000208:Acute Disease; D000293:Adolescent; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004185:Disability Evaluation; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012008:Recurrence; D012494:Sampling Studies; D016896:Treatment Outcome; D014505:Urban Population