Compliance with the Canadian Association of Emergency Physicians' asthma clinical practice guidelines at a tertiary care emergency department.
BACKGROUND
Although evidence-based clinical practice guidelines (CPGs) exist, emergency department (ED) asthma management remains highly variable. Our objective was to compare asthma management at a tertiary care ED with that advised by the Canadian Association of Emergency Physicians' (CAEP) asthma CPG and current best practice.


METHODS
This medical record study enrolled patients between the ages of 19 and 60 years with a previous diagnosis of asthma who were seen for an acute asthma exacerbation at the Vancouver General Hospital ED in 2008. Standard methodology guidelines for medical record review were followed, including explicitly defined criteria and determination of interrater reliability. Primary outcomes were the proportion of cases with the following: objective assessment of severity using peak expiratory flow (PEF), use of systemic corticosteroids (SCSs) in the ED and at discharge, prescription for any inhaled corticosteroids (ICSs), and documentation of outpatient follow-up.


RESULTS
A total of 204 patient encounters were enrolled. Kappa values for interrater assessment ranged from 0.93 to 1.00. Compliance with primary outcomes was as follows: measurement of PEF, 90% (95% CI 85-94); use of SCSs in the ED, 64% (95% CI 57-71); prescription of SCSs at discharge, 59% (95% CI 51-67); prescription of any ICS at discharge, 51% (95% CI 41-61); and documentation of outpatient follow-up, 78% (95% CI 71-84).


CONCLUSIONS
This study indicates an improvement in ED asthma care compared to previously published studies; however, discordance still exists between asthma management at a tertiary care ED and the CAEP asthma CPG and current best practice. Further research is warranted to understand the reasons for this finding.
Department of Emergency Medicine, University of British Columbia, Vancouver, BC. filiatra@interchange.ubc.ca
Lyne
L
Filiatrault
David
D
Harriman
Riyad B
RB
Abu-Laban
J
J
Mark FitzGerald
Anthony M
AM
Chahal
R
R
Douglas McKnight
D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000328:Adult; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D002170:Canada; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D003266:Continuity of Patient Care; D004282:Documentation; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004635:Emergency Medicine / Q000592:standards*; D004636:Emergency Service, Hospital; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D019983:Guideline Adherence; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D010351:Patient Discharge; D010366:Peak Expiratory Flow Rate / Q000502:physiology; D017410:Practice Guidelines as Topic; D011241:Prednisone / Q000627:therapeutic use; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D055815:Young Adult
D000318:Adrenergic beta-Agonists; D018680:Cholinergic Antagonists; D005938:Glucocorticoids; D011241:Prednisone; D008775:Methylprednisolone