The impact of national guidelines on the assessment and management of acute paediatric asthma presenting at a tertiary children's emergency department.
BACKGROUND
Recent Scottish Intercollegiate Guidelines Network/British Thoracic Society guidelines have highlighted best practice for asthma management. This study examines asthma management in a paediatric emergency setting before and after the publication of these guidelines.


OBJECTIVE
To assess the impact of Scottish Intercollegiate Guidelines Network/British Thoracic Society guidelines on asthma management.


METHODS
Retrospective review of patient notes over two equivalent 2-month periods in 2002 and 2003. Main outcomes were documentation of clinical history, examination, investigation, treatment and discharge; and also the use of various treatment modalities in each case.


RESULTS
One hundred and sixty-four children presented with asthma, 100 in 2002 and 64 in 2003. Documentation was adequate throughout, though better when nursing staff were responsible. Completeness of documentation was not related to seniority or discipline of medical staff. Measurement of peak flow was poor in both years. The 'doubling up' of inhaled steroid dose for acute episodes was the only aspect of management affected by publication of the guidelines, with significantly fewer patients receiving this in 2003 (P<0.0001).


CONCLUSIONS
Documentation within the centre is good but has potential for improvement. Guidelines have not impacted on this except when explicit statements are made regarding treatment.
Reynolds
Ben C
BC
Department of Medical Paediatrics, Royal Hospital for Sick Children, Edinburgh, UK.
Beattie
Thomas F
TF
Cunningham
Steve
S
D000208:Acute Disease; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000592:standards*; D005938:Glucocorticoids / Q000627:therapeutic use; D019983:Guideline Adherence; D006776:Hospitals, Pediatric / Q000592:standards*; D006801:Humans; D007223:Infant; D008330:Management Audit; D017410:Practice Guidelines as Topic; D011239:Prednisolone / Q000627:therapeutic use; D012189:Retrospective Studies; D012606:Scotland
D005938:Glucocorticoids; D011239:Prednisolone