OBJECTIVE. We sought to study the impact of emergency department (ED)-based intensive primary care linkage and initiation of asthma case management on long-term, patient-oriented outcomes for children with an asthma exacerbation.METHODS. Our study was a randomized, 3-arm, parallel-group, single-blind clinical trial. Children aged 2 through 17 years treated in a pediatric ED for acute asthma were randomly assigned to standard care (group 1), including patient education, a written care plan, and instructions to follow up with the primary care provider within 7 days, or 1 of 2 interventions. Group 2 received standard care plus assistance with scheduling follow-up, while group 3 received the above interventions, plus enrollment in a case management program.OUTCOMES. The primary outcome was the proportion of children having an ED visit for asthma within 6 months. Other outcomes included change in quality-of-life score and controller-medication use.RESULTS. Three hundred fifty-two children were enrolled; 78% completed followup, 69% were black, and 70% had persistent asthma. Of the children, 37.8% had a subsequent ED visit for asthma, with no difference among the treatment groups (group 1: 38.4%; group 2, 39.2%; group 3, 35.8%). Children in all groups had a substantial, but similar, increase in their quality-of-life score. Controller-medication use increased from 69.4% to 81.4%, with no difference among the groups.CONCLUSION. ED-based attempts to improve primary care linkage or initiate case management are no more effective than our standard ED care in improving subsequent asthma outcomes over a 6-month period. A STHMA, WHICH AFFECTS Ͼ6 million US children, is a chronic disease marked by acute exacerbations that account for much of the associated morbidity. 1-3 Much of the care of these acute flare-ups is provided in emergency departments (EDs), with Ͼ728 000 ED visits for childhood asthma in 2000. 1 Because the ED is a frequent source of care for patients with asthma, it may have a role in chronic disease management as well. 4 A 2002 publication by an expert panel outlined multiple policy recommendations to improve childhood asthma outcomes. 5 Three of these recommendations focused on improving access to and quality of asthma health care services, improving primary asthma care, and providing case management (CM) for high-risk asthmatic children.Linkage between the ED and the source of primary asthma care has been the subject of some investigation. In 1997, the National Asthma Education and Prevention Program (NAEPP) Expert Panel Report 2 6 emphasized the importance of ongoing preventive care and follow-up with a primary care provider (PCP) after acute care treatment in reducing asthma morbidity. However, although NAEPP guidelines recommend follow-up with a PCP within 3 to 5 days of an acute asthma exacerbation, numerous studies have demonstrated low rates of compliance with this recommendation. 7,8 A variety of strategies have been found to improve the rate of post-ED care follow-up, including scheduling of fo...

This pilot study suggests that disimpaction by enema may be superior to PEG for immediate relief of symptoms. Larger trials are needed to assess any advantage.

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A protocol to initiate PCA for sickle cell patients in a pediatric emergency department shortened the time of its initiation and was preferred by patients.

It appears that the serum NSE level can be used as a predictor of global short-term physical disability in children following cTBI.