The Frequency of Reevaluation or Peak Flow Meter Documentation in Acute Asthma Exacerbations in the Emergency Department: Are We Treating in Accordance with NIH/NAEPP Guidelines?
OBJECTIVE
To evaluate the frequency of peak expiratory flow rate (PEFR) measurement and clinical re-evaluation in the management of ED asthmatic patients.


METHODS
This was a retrospective chart review examining consecutive asthma patients who presented to the University of California Irvine ED between September 1, 2003 and December 31, 2003. Patients were excluded if they had a diagnosis of COPD, lung cancer, pneumonia, congestive heart failure, alpha 1 anti-trypsin deficiency or were under 5 years of age. Data collected included patient demographics, pulse oximetry reading(s), ED treatments rendered, and frequencies of PEFR measurement (pre and post therapy), of clinical re-evaluations in the ED, and of ED return visits.


RESULTS
Of the 122 ED visits from 111 patients, 11 (10%) patients returned during the 4 month study period, with 5 patients (4.5%) returning in less than 72 hours. Seven (6.0%) patients had PEFR done both pre and post treatment and 24 (20%) had one or more PEFR performed either before or after treatment. Only 61 (50%) of the visits had a documented clinical re-evaluation prior to disposition.


CONCLUSIONS
Despite their documented role in asthma treatment algorithms, PEFR was performed infrequently and clinical re-evaluation was documented in only half of cases. Recommended algorithms for asthma management were not commonly followed in this academic ED.
Hodgson
Danner
D
Department of Emergency Medicine, University of California, Irvine Medical Center.
Rudkin
Scott E
SE
Oman
Jennifer A
JA
Fisher
Jason
J