The prehospital administration of intravenous methylprednisolone lowers hospital admission rates for moderate to severe asthma.
OBJECTIVE
To compare hospital admission rates for patients with moderate to severe asthma who receive intravenous methylprednisolone given in the prehospital setting versus in the emergency department.


METHODS
A retrospective chart review was used to identify emergency medical services (EMS) transports of patients with moderate to severe asthma when 125 mg methylprednisolone was given intravenously in the prehospital setting under existing regional protocols. Data were collected on EMS runs in an urban/suburban system from May 1, 2000, through April 30, 2001. Only patients 18 to 50 years old with a history of asthma were included in the study. Patients were excluded if they left against medical advice, were long-term smokers, used home oxygen, or had a history of chronic obstructive pulmonary disease. A parallel search was performed from February 1, 1999, to April 30, 2000, to identify moderate-severe asthmatics who were transported by EMS and later given intravenous methylprednisolone in the emergency department. During this period, methylprednisolone was not available for use in this EMS system.


RESULTS
A total of 31 moderate to severe asthmatics were identified as receiving prehospital methylprednisolone. A total of 33 asthmatics were identified who were transported by EMS and later received intravenous methylprednisolone in the emergency department. Average patient age in the prehospital methylprednisolone group was 34+/-10 years (mean+/-standard deviation; 95% confidence interval [CI]=31-37). Average age in the hospital group was 34+/-10 years (95% CI=31-37). Average time to administration of methylprednisolone in the prehospital setting was 15+/-7 minutes (95% CI=7-22). The average time elapsed in the emergency department before methylprednisolone was 40+/-22 minutes (95% CI=23-57). Only 12.9% (4) of the patients receiving prehospital solumedrol were admitted versus 33.3% (11) of those receiving the medication in the emergency department (p=0.025). Patients were 3.375 times more likely to be admitted if they received methylprednisolone in the emergency department versus in the prehospital setting.


CONCLUSIONS
Patients with moderate to severe asthma who receive intravenous methylprednisolone in the prehospital setting have significantly fewer hospital admissions.
Department of Emergency Medicine, Raleigh Building Room 304, Eastern Virginia Medical School, Norfolk, VA 23507-1999, USA. loriandbar@aol.com
Barry
B
Knapp
Chris
C
Wood
D000328:Adult; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy*; D015331:Cohort Studies; D016001:Confidence Intervals; D004632:Emergency Medical Services / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012424:Rural Population; D012720:Severity of Illness Index; D013224:Status Asthmaticus / Q000175:diagnosis / Q000188:drug therapy; D016896:Treatment Outcome; D014505:Urban Population
D008775:Methylprednisolone