title: Acute obstructive respiratory tract diseases in a pediatric emergency unit: evidence-based evaluation.
abstract: OBJECTIVE
  The objective of this study was to determine the evidence-based performance of the pediatric emergency unit in the diagnosis of and treatment approach to the patients with asthma, bronchiolitis, and croup.
  
  
  METHODS
  In this study conducted in a retrospective cross-sectional way, emergency cards and computer data have been used. In the performance evaluation, the National Hospital Ambulatory Medical Care Survey criteria were considered. In the evaluation of performance in diagnosis, the rates of chest x-ray studies and use of corticosteroids and antibiotics were examined. Use of antibiotics in the cases not having a fever or any symptoms of bacterial infection and failure in prescribing steroids to the cases with moderate-to-severe symptoms were considered as bad performance criteria. χ(2) test was used for the data, which can be classified; Mann-Whitney U and Student t tests were used for the data with normal distribution and for the continuous variables.
  
  
  RESULTS
  Study groups were composed of 2795 patients (1742 cases with asthma, 115 cases with croup, 938 cases with bronchiolitis) aged between 3 and 140 months (mean [SD], 41.2 [31] months). Chest x-ray study was requested significantly more often in the cases of bronchiolitis and croup with severe symptoms. In asthma cases, chest x-ray study was requested in those with severe clinical symptoms. In all 3 groups, a significant difference between the severity levels of the cases, from whom hemogram was requested, was determined. Biochemical tests were requested more often in those with severe bronchiolitis or asthma. Antibiotics were prescribed to none of the mild bronchiolitis cases. However, steroids were recommended more often to patients with moderate and severe bronchiolitis. They were administered to all patients with croup. Systemic steroids were prescribed more often to those with moderate or severe asthma.
  
  
  CONCLUSIONS
  In our unit, both antibiotics administration and chest x-ray studies requested in patients with bronchiolitis, croup, and asthma were in low rates. Steroids in asthma attacks were found to be high in severe cases and in croup cases as well.
authors.affiliation: Division of Ambulatory Pediatrics, University of Istanbul, Istanbul, Turkey. ayse.kilic@tnn.net
authors.forename: Ayse
authors.initials: A
authors.lastname: Kilic
authors.forename: Emin
authors.initials: E
authors.lastname: Ünüvar
authors.forename: Murat
authors.initials: M
authors.lastname: Sütçü
authors.forename: Ayşe
authors.initials: A
authors.lastname: Süleyman
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Tamay
authors.forename: Ismail
authors.initials: I
authors.lastname: Yildiz
authors.forename: Fatma
authors.initials: F
authors.lastname: Oguz
authors.forename: Müjgan
authors.initials: M
authors.lastname: Sidal
authors.forename: Nermin
authors.initials: N
authors.lastname: Güler
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000402:Airway Obstruction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001249:Asthma / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D001774:Blood Chemical Analysis / Q000706:statistics & numerical data; D001988:Bronchiolitis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003440:Croup / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D004363:Drug Utilization; D004636:Emergency Service, Hospital; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D007223:Infant; D017410:Practice Guidelines as Topic; D013902:Radiography, Thoracic / Q000706:statistics & numerical data; D012189:Retrospective Studies; D063189:Symptom Assessment; D014421:Turkey / Q000453:epidemiology; D019564:Unnecessary Procedures
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D000900:Anti-Bacterial Agents