A Comparison Between Emergency Diagnostic and Treatment Unit and Inpatient Care in the Management of Acute Asthma

McDermott, Michael; Murphy, Daniel G.; Zalenski, Robert J.; Rydman, Robert J.; McCarren, Madeline; Marder, David; Jovanovic, Borko; Kaur, Kulvinder; Roberts, Rebecca; Isola, Miriam; Mensah, Edward; Rajendran, Rosula; Kampe, Linda M.

doi:10.1001/archinte.1997.00440390041006

Cited by 87 publications

(15 citation statements)

References 17 publications

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“…Since then the number of emergency department visits has increased at an 8.4% compounded annual growth rate from 1992 through 1995. Because patients with asthma treated in the emergency department incur significantly lower costs than those admitted to the hospital, and those who fail to respond to the emergency department treatment and require subsequent admission to the hospital constitute the least cost efficient subset,22 emergency room physicians are under pressure to determine as quickly as possible whether a patient is to be discharged or admitted. Furthermore, the US Public Health Service has made decreasing the need for inpatient treatment of asthma a national priority 23.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the effects of intravenous and oral montelukast on airway function: a double blind, placebo controlled, three period, crossover study in asthmatic patients

Dockhorn¹

2000

Thorax

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Comparison of the eVects of intravenous and oral montelukast on airway function: a double blind, placebo controlled, three period, crossover study in asthmatic patients R J Dockhorn, R A Baumgartner, J A LeV, M Noonan, K Vandormael, W Stricker, D E Weinland, T F Reiss Abstract Background-Montelukast, a leukotriene receptor antagonist, improves parameters of asthma control including forced expiratory volume in one second (FEV 1 ) when given orally to patients aged six years or older. This study was undertaken to compare the eVect on FEV 1 of intravenous and oral montelukast and placebo during the 24 hour period following administration. Methods-Fifty one asthmatic patients (FEV 1 40-80% predicted and >15% improvement after inhaled agonist) were enrolled in a double blind, single dose, three period, crossover study to receive intravenous montelukast (7 mg), oral montelukast (10 mg), or placebo in a randomised fashion. The primary end point was area under the curve (AUC) 0-24 h of the percentage change from baseline in FEV 1 . Additional end points were maximum percentage change in FEV 1 and percentage change at diVerent time points. Results-Compared with placebo, intravenous and oral montelukast significantly increased the AUC 0-24 h (means of 20.70%, 15.72%, and 7.75% for intravenous, oral and placebo, respectively; no statistical diVerence between intravenous and oral). The diVerence in least square means from placebo for intravenous montelukast was 13.27% (95% CI 7.07 to 19.46), p<0.001 and for oral montelukast was 7.44% (95% CI 1.20 to 13.68), p = 0.020. The maximum percentage change in FEV 1 was not significantly diVerent for intravenous and oral montelukast (diVerence in least square means 6.78% (95% CI -0.59 to 14.15), p = 0.071). The mean percentage change in FEV 1 for intravenous montelukast was greater than for oral montelukast within the first hour (15.02% vs 4.67% at 15 min, p<0.001; 18.43% vs 12.90% at one hour, p<0.001 for intravenous and oral montelukast, respectively (placebo 3.05% at 15 minutes, 7.33% at one hour). Intravenous and oral montelukast were similar to placebo in the frequency of adverse events. Conclusions-The onset of action for intravenous montelukast was faster than for oral montelukast and the improvement in airway function lasted over the 24 hour observation period for both treatments. Although not well understood, there was a trend toward a greater improvement in FEV 1 with intravenous than with oral montelukast. These findings suggest that leukotriene receptor antagonists should be investigated as a treatment for acute severe asthma. (Thorax 2000;55:260-265)

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Section: Discussionmentioning

confidence: 99%

Comparison of the effects of intravenous and oral montelukast on airway function: a double blind, placebo controlled, three period, crossover study in asthmatic patients

Dockhorn¹

2000

Thorax

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“…13,16,[20][21][22][23] After modifications to optimize the outcome-assessment survey for the IEDAC study, feasibility testing of the survey was conducted with 161 patients using either a telephone version only or a mailed version with telephone follow-up for nonresponders to the mailed version. Telephone administration was chosen for the final version based on optimal survey completion and item-response rates.…”

Section: Development Of the Outcome-assessment Surveymentioning

confidence: 99%

Improving Pediatric Asthma Care Through Surveillance: The Illinois Emergency Department Asthma Collaborative

Lenhardt¹,

Catrambone²,

McDermott³

et al. 2006

Pediatrics

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OBJECTIVES. To better understand and improve the care of asthma patients who require emergency department (ED) care, the Illinois Emergency Department Asthma Collaborative (IEDAC) was created to develop, test, and disseminate an ED-based surveillance system. This report describes the development and testing of the pediatric IEDAC surveillance instruments and demonstrates how these instruments can be used to describe the health status, healthcare delivery, and outcome of children using ED services.METHODS. A convenience sample of 128 children presenting to 5 EDs in Illinois for asthma care was the study base. Data were collected on monthly samples of children aged 2 through 17 years who presented to these EDs from May to November 2003. Three instruments were used to collect data regarding the children's pre-ED, ED, and post-ED experience.RESULTS. At the ED visit, 73.4% of children met national guideline criteria for persistent-level asthma symptoms. Among this group, 53.2% were using inhaled corticosteroid (ICS) medications. At 1 month follow-up, 66.6% of the children met the criteria for persistent-level asthma symptoms, which was statistically unchanged from the ED visit. Among the latter group, 64.2% were using ICS medications, again statistically unchanged compared with the ED visit. At followup, 24.5% of children were reported to have returned to an ED or were subsequently hospitalized. The majority of children were noted at follow-up to have limitation of at least some activity.CONCLUSIONS. Children who presented to IEDAC EDs were found to have a high level of asthma burden that continued at follow-up despite treatment. Moreover, a substantial proportion of children had returned to an ED or were subsequently hospitalized. Encouraging trends in medication use were observed, although suboptimal medication use was also observed.

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“…Evaluando el impacto de la UEC en el número de pacientes que ingresan por dolor torácico, Farkouh y col 8 en su estudio incluyó 212 pacientes con dolor torácico de riesgo intermedio, apreciándose una disminución de ingresos en la UHC al ser ingresados en una UEC. Mc Dermott y col 19 en su estudio aleatorizado controlado en pacientes con asma que no pudieron ser dados de alta tras 3 horas de estancia en el SUH apreciaron que en el grupo de 110 pacientes tratados en una UEC, el 59% de los pacientes fueron dados de alta a domicilio y el 41% fue ingresado en la UEC. Brillman y col 20 estudiaron la evolución de 834 pacientes antes de abrir una UHC y 390 pacientes tras abrir la UEC.…”

Section: Métodounclassified

“…Las UEC permiten disminuir los ingresos no necesarios en camas de hospitalización convencional, mejorar la atención percibida por el paciente y disminuir probablemente el porcentaje de infección nosocomial. Para el correcto funcionamiento de estas unidades se deben cumplir una serie de requerimientos [14][15][16][17][18][19][20][21][22][23][24][25] : idealmente deben de encontrarse bajo manejo por médicos internistas; el tiempo de estancia debe limitarse a una máxima de 96 horas; los objetivos por paciente deben de estar claramente definidos; no deben de utilizarse como comodín cuando faltan camas en las UHC y si el paciente tuviera que ingresar, el ingreso debe tener prioridad sobre otros pacientes para poder mantener el índice de rotación pactado, lo que hace que las UEC sean unidades altamente dinámicas [26][27][28] . En definitiva, podemos afirmar que en la gestión sanitaria, las UEC son una herramienta de optimización de los recursos sanitarios públicos 29 .…”

Section: Métodounclassified

En plena crisis económica: coste y efectividad de las unidades de estancia corta hospitalarias

Epelde

Iglesias-Lepine

Anarte

2012

Anales Sis San Navarra

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A Comparison Between Emergency Diagnostic and Treatment Unit and Inpatient Care in the Management of Acute Asthma

Abstract: Treatment of selected patients with asthma in an EDTU results in the safe discharge of most such patients. This study suggests that quality gains and cost-effective measures can be achieved by the use of such units.

Cited by 87 publications

References 17 publications

Comparison of the effects of intravenous and oral montelukast on airway function: a double blind, placebo controlled, three period, crossover study in asthmatic patients

Comparison of the effects of intravenous and oral montelukast on airway function: a double blind, placebo controlled, three period, crossover study in asthmatic patients

Improving Pediatric Asthma Care Through Surveillance: The Illinois Emergency Department Asthma Collaborative

En plena crisis económica: coste y efectividad de las unidades de estancia corta hospitalarias

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