Variations and gaps in management of acute asthma in Ontario emergency departments.
BACKGROUND
Variation in hospitalization rates for acute asthma in Ontario may reflect gaps between evidence and current emergency department (ED) management. We investigated ED management of asthma and differences in practice patterns for pediatric (< 20 years old) and adult (> or = 20 years old) patients in Ontario EDs.


METHODS
Patient characteristics and ED management during a 1-year period were assessed by questionnaire and chart abstractions in a stratified sample of 16 Ontario hospitals. Variation between sites was assessed by one-way analysis of variance, Kruskal-Wallis test, or chi(2) test.


RESULTS
Reported results are based on the first of 2,671 pediatric (42.0% female) and 2,078 adult (66.7% female) visits with a corresponding questionnaire. Asthma severity, comorbidities, access to care, and prehospital management varied significantly among sites (all p < 0.001). Documentation of peak expiratory flow (27.2% of pediatric [age > or = 7] and 44.3% of adult charts), use of systemic steroids in ED (35.2% pediatric and 33.0% adult charts) and on discharge (31.7% pediatric and 33.2% adult charts), and referrals to asthma services (2.8% pediatric and 2.7% adult charts) varied among sites (all p < 0.001). Admission (%) was directly related to time to receive systemic steroids in ED in adults (r = 0.76; p = 0.004). Repeat ED visits (%) were inversely related to new inhaled steroid prescription on discharge in adults (r = -0.64; p = 0.02).


CONCLUSIONS
Knowledge translation initiatives are warranted to increase adherence with best practices in emergency management of asthma (such as objective assessment of airflow rates, use of systemic steroids, and referrals) in order to reduce variations in care and improve outcomes of severe acute asthma.
Lougheed
M Diane
MD
Queen's University, Kingston, ON, Canada; Clinical Research Centre, Kingston General Hospital, Kingston, ON, Canada. Electronic address: mdl@queensu.ca.
Garvey
Nancy
N
William Osler Health Centre, Brampton, ON, Canada.
Chapman
Kenneth R
KR
University of Toronto, Toronto, ON, Canada.
Cicutto
Lisa
L
University of Toronto, Toronto, ON, Canada.
Dales
Robert
R
University of Ottawa, Ottawa, ON, Canada.
Day
Andrew G
AG
Clinical Research Centre, Kingston General Hospital, Kingston, ON, Canada.
Hopman
Wilma M
WM
Clinical Research Centre, Kingston General Hospital, Kingston, ON, Canada.
Lam
Miu
M
Queen's University, Kingston, ON, Canada.
Sears
Malcolm R
MR
McMaster University, Hamilton, ON, Canada.
Szpiro
Kim
K
Clinical Research Centre, Kingston General Hospital, Kingston, ON, Canada.
To
Teresa
T
Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.
Paterson
Nigel A M
NAM
University of Western Ontario, London, ON, Canada.
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D019983:Guideline Adherence; D006760:Hospitalization; D006801:Humans; D008297:Male; D009864:Ontario; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation
D018927:Anti-Asthmatic Agents; D005938:Glucocorticoids