Effectiveness of Pediatric Asthma Pathways in Community Hospitals: A Multisite Quality Improvement Study

Desai, Mansi; Caldwell, Katherine; Gupta, Nisha; Bekmezian, Arpi; Cabana, Michael D.; Auerbach, Andrew D.; Kaiser, Sunitha V.

doi:10.1097/pq9.0000000000000355

Cited by 10 publications

(27 citation statements)

References 23 publications

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“…Therefore, every effort should be taken to alter this current practice and the habits of unnecessary use of medical radiation (including computerized tomography scan) for these youngsters [15][16]. Suggested recommendations toward this goal include: (1 ) Educating healthcare providers about potential adverse events coupled with diagnostic radiation (e.g., the AAP initiative for "improving the value of care delivered to children with asthma") [17-18], (2 ) Relying on the medical history and physical examination to attain clinical assessment [19][20] ; (3 ) Regulating radiation equipments to deliver minimum necessary dosing [14], (4 ) Establishing evidence-based thresholds for the allowed radiation dose as function of age [21], and (5 ) Advancing ultrasound and magnetic resonance imaging (MRI) technologies to replace the diagnostic radiation procedures.…”

Section: Discussionmentioning

confidence: 99%

A Single-Institution Experience in the Use of Chest Radiographs for Hospitalized Children Labelled as Asthma Exacerbation

Beyyumi

Tawil

AlDhanhani

et al. 2021

Preprint

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Background: Risks of cancer have become more notable lately, especially for young children with a chronic condition such as atopy. This study reports on cumulative radiation from chest radiographs in children with asthma. Its main aims were to consider our current practice, and suggest minimizing chest radiograph use in this vulnerable people. Methods: The study was retrospective and conducted at tertiary center. Eligibility criteria included children 2-15 y who were admitted between January-2017 and December-2018 for asthma management. Results: Of 643 children who were admitted as ‘asthma exacerbation’, 243 (40% females; age [mean±SD] 5.4±3.3 y) met the study criteria for inclusion. Ninety-two (38%) children had temperature 38.8±0.7oC on the day of admission. Antibiotics were prescribed for 148 (61%) children, mainly for presumed pneumonia. Chest radiographs were requested for 214 (88%) children, mainly on the day of admission. Only 38 (18%) chest radiographs showed focal/multifocal pneumonia justifying antibiotic use. Significant predictors for requesting chest radiographs were antibiotic use for presumed pneumonia, lower oxygen saturation at presentation, and requesting blood culture. Rate of chest radiographs per year was negatively related to child’s age; the younger the child the higher the rate (model coefficient -0.259, P<0.001). For children <5 y, rate of chest radiographs was 1.39±1.21/y and radiation dose 0.028±0.025 mSV/y. The corresponding rates for children ≥5 y were 0.78±0.72/y and 0.008±0.007 mSV/y, respectively (P<0.001). Conclusion: Chest radiographs were commonly requested for children with asthma, especially the young ones. Prospective studies are necessary to measure the impact of this practice on their health.

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Section: Discussionmentioning

confidence: 99%

A Single-Institution Experience in the Use of Chest Radiographs for Hospitalized Children Labelled as Asthma Exacerbation

Beyyumi

Tawil

AlDhanhani

et al. 2021

Preprint

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“…Of the seven papers included in the previous review, two were included in the present review 15,30 , three were published prior to 2000, one was published French and one did not meet inclusion criteria. Nineteen studies 9,10, 16,17,21,23,24,26,27,[31][32][33][34][35][36][37][38][39][40] were published after the search in the previous review. 11…”

Section: Study Selectionmentioning

confidence: 99%

“…Thirteen studies were from North America, 16,17,23,24,26,[28][29][30][34][35][36][37]39 eight from Europe, 9,10,15,21,22,31,32,38 six from Australia, 18,20,25,27,40,41 and one from Asia. 33 Nineteen studies had a before-and-after design and four 22,32,33,35 compared non-randomised assessment options within the same period.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…25 Only one study 16 included any participants ≥18 years, and here 87% of participants were aged <13 years. The earliest studies began in 18,29 and the latest in 2017; 36 seven studies began between 1990-1999, 15,18,25,29,30 ten between 2000-2009 10,16,17,[22][23][24]28,31,35,38 and eleven after 2009. 9, 21,26,27,[32][33][34]36,37,39,40…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Hospital admission was reported in studies, 9,10,15,16,[18][19][20]22,23,[25][26][27][28][29][30][31][32][34][35][36][38][39][40] readmission in nine, 17,[19][20][21]24,26,39 and length of stay in 15 studies. 10,16,[18][19][20][21]23,24,[26][27][28][29][30]36,37 The primary outcome was presented as odds ratio (OR) or relative risk (RR) of hospital admission [15][16][17]22,32,34,35...…”

Section: Outcome Measuresmentioning

confidence: 99%

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Interventions to reduce acute paediatric hospital admissions: a systematic review

et al. 2021

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BackgroundAdmission rates are rising despite no change to burden of illness, and interventions to reduce unscheduled admission to hospital safely may be justified.ObjectiveTo systematically examine admission prevention strategies and report long-term follow-up of admission prevention initiatives.Data sourcesMEDLINE, Embase, OVID SP, PsychINFO, Science Citation Index Expanded/ISI Web of Science, The Cochrane Library from inception to time of writing. Reference lists were hand searched.Study eligibility criteriaRandomised controlled trials and before-and-after studies.ParticipantsIndividuals aged <18 years.Study appraisal and synthesis methodsStudies were independently screened by two reviewers with final screening by a third. Data extraction and the Critical Appraisals Skills Programme checklist completion (for risk of bias assessment) were performed by one reviewer and checked by a second.ResultsTwenty-eight studies were included of whom 24 were before-and-after studies and 4 were studies comparing outcomes between non-randomised groups. Interventions included referral pathways, staff reconfiguration, new healthcare facilities and telemedicine. The strongest evidence for admission prevention was seen in asthma-specific referral pathways (n=6) showing 34% (95% CI 28 to 39) reduction, but with evidence of publication bias. Other pathways showed inconsistent results or were insufficient for wider interpretation. Staffing reconfiguration showed reduced admissions in two studies, and shorter length of stay in one. Short stay admission units reduced admissions in three studies.Conclusions and implicationsThere is little robust evidence to support interventions aimed at preventing paediatric admissions and further research is needed.

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Adherence to the asthma pathway, including pre-triage bronchodilator history, reduces hospitalizations

Ittiporn,

Prajongdee

2023

Journal of Asthma

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Effectiveness of Pediatric Asthma Pathways in Community Hospitals: A Multisite Quality Improvement Study

Abstract: Supplemental Digital Content is available in the text.

Cited by 10 publications

References 23 publications

A Single-Institution Experience in the Use of Chest Radiographs for Hospitalized Children Labelled as Asthma Exacerbation

A Single-Institution Experience in the Use of Chest Radiographs for Hospitalized Children Labelled as Asthma Exacerbation

Interventions to reduce acute paediatric hospital admissions: a systematic review

Adherence to the asthma pathway, including pre-triage bronchodilator history, reduces hospitalizations

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