title: Monitoring the hospital management of acute asthma: the Italian Pediatric Network experience.
abstract: BACKGROUND
  The Study Group on Accreditation and Quality Improvement of the Italian Society of Pediatrics has developed an observational study about the hospital management of pediatric patients affected by severe asthma, in order to evaluate how the Guidelines for severe asthma in childhood are applied in the daily practice.
  
  
  METHODS
  This study included patients between 2 and 17 years, hospitalized or under short intensive observation for acute asthma. The data collection was carried out through the compilation of on-line forms. The statistical technique used was the Chi Square test.
  
  
  RESULTS
  409 forms were filled in by 32 Italian Centers. 17% of the patients showed severe asthma, 59% moderate and 24% mild. On arrival at the Emergency Room the oximetry was measured in 95% of the patients, the respiratory rate in 64% while the heart rate in 88% of them. 48% of the children were exposed to chest X-ray. More than half of the children received oxygen therapy, 98.5% received short-acting beta-2 agonists and systemic steroid therapy was given to 82% of children, mainly orally. At discharge only half of the children were provided with written instructions for the management of any subsequent asthmatic episode. The analysis of the collected data highlights that not all the children had their oxygen saturation measured, although this parameter is one of the main indicators of disease severity, as well as the respiratory rate, which was detected in a minimal percentage of cases. The frequency of chest X-ray was extremely high, even though it does not have any indication in the majority of asthma cases. The evaluation of the therapeutic treatment denotes an adequate use of the oxygen therapy according to the oximetry values found on arrival, but an abuse of steroid therapy. Critical issues emerge at discharge: children are not always educated about the home management of the disease and the self-evaluation of the illness seriousness.
  
  
  CONCLUSIONS
  The pediatric network has become an excellent system of monitoring of the clinical management of asthmatic children, highlighting strengths and weaknesses on which to focus actions of improvement.
authors.affiliation: Department of Pediatrics, S. Corona Hospital, Garbagnate - Milano, Italy.
authors.forename: A G
authors.initials: AG
authors.lastname: Martelli
authors.affiliation: Department of Pediatrics, S. Corona Hospital, Garbagnate - Milano, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Bianchi
authors.affiliation: Department of Pediatrics, AO Ospedale Civile di Legnano, Legnano - Milano, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Boldrighini
authors.affiliation: Department of Pediatrics, AO Ospedale Civile di Legnano, G. Fornaroli Hospital, Magenta - Milano, Italy. E-mail: mariangela.bosoni@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Bosoni
authors.affiliation: Department of Health data and programming, S. Corona Hospital, Garbagnate - Milano, Italy.
authors.forename: A
authors.initials: A
authors.lastname: De Vuono
authors.affiliation: Department of Pediatrics, AO Ospedale Civile di Legnano, Legnano - Milano, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Flores D'Arcais
authors.affiliation: Department of Pediatrics, Hospital of Lodi, Lodi, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Gargantini
authors.affiliation: Pediatric Division, St. Anna Hospital, Como, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Longhi
authors.affiliation: Pediatric Division, St. Anna Hospital, Como, Italy.
authors.forename: M T
authors.initials: MT
authors.lastname: Ortisi
authors.affiliation: Department of Pediatrics, AO Ospedale Civile di Legnano, G. Fornaroli Hospital, Magenta - Milano, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Racchi
authors.affiliation: Department of Pediatrics, AO Ospedale Civile di Legnano, G. Fornaroli Hospital, Magenta - Milano, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Parola
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D019983:Guideline Adherence; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007223:Infant; D007558:Italy; D008297:Male; D010372:Pediatrics / Q000379:methods / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods*
keywords: GSAQ; asthma; children; hospital management