Prehospital management of pediatric asthma patients in a large emergency medical services system

Abstract

BackgroundAsthma is a common pediatric diagnosis for emergency medical services (EMS) transports, however there is a paucity of data on prehospital asthma management. The purpose of this study was to describe prehospital management of pediatric patients with suspected asthma exacerbation.MethodsWe conducted a retrospective review of electronic medical records from 24 ground EMS agencies in Southwestern Pennsylvania between 1 January 2014 to 31 December 2017. We identified patients 2 to 17 years with documented wheezing, excluding those with suspected anaphylaxis. Patients with documented respiratory distress were classified as severe asthma. We report descriptive statistics of demographics, vital signs, and management including administration of medications and performance of procedures.ResultsOf 19 246 pediatric transports, 1078 (5.6%) patients had wheezing. Of these, 532 (49%) met criteria for severe asthma. Patients with severe asthma were more likely to be adolescents compared to those with nonsevere asthma (49.6% vs 6%; P < .001). While rates of intravenous methylprednisolone administration were higher in patients with severe asthma (68/532, 12.8%) compared to those with nonsevere asthma (13/546, 2.4%; P < .001), overall use of steroids was low (7.5%). Other therapies provided included albuterol (n = 699, 64.8%), ipratropium bromide (n = 271, 25.1%), and oxygen (n = 280, 26.0%). One hundred eighty patients (16.7%) received a peripheral IV line. Two patients (0.4%) were given continuous positive airway pressure.ConclusionApproximately 6% of pediatric EMS transports are for asthma. Steroid usage was low in even those with severe asthma, representing an area of process improvement. These data provide a baseline to future research to identify interventions that may improve outcomes.

Variation in Prehospital Protocols for Pediatric Respiratory Distress Management in the United States

“…Studies performed in Pennsylvania, Florida, and New Mexico each suggest a low rate of administration of intravenous steroids in prehospital encounters for pediatric patients with asthma exacerbations. 5,8,9 In one pilot study, a change in prehospital protocols to include oral dexamethasone administration paired with training increased glucocorticoid administration to asthmatic pediatric patients, with a decrease in hospital admission rate and length of stay. 10 Several studies have demonstrated that dexamethasone and methylprednisolone carry similar efficacy for asthma, 17 and a systematic review of randomized controlled trials identified that oral steroid therapy is particularly effective in pediatric patients.…”

“…Several randomized controlled trials have demonstrated that earlier use of steroids in patients with asthma significantly reduces symptoms and the need for hospital admission, especially in patients with severe asthma 16 However, even in states where steroid use was permissible, their rate of use in pediatric patients is low. Studies performed in Pennsylvania, Florida, and New Mexico each suggest a low rate of administration of intravenous steroids in prehospital encounters for pediatric patients with asthma exacerbations 5,8,9 . In one pilot study, a change in prehospital protocols to include oral dexamethasone administration paired with training increased glucocorticoid administration to asthmatic pediatric patients, with a decrease in hospital admission rate and length of stay 10 .…”

“…[2][3][4] An additional study from Southwestern Pennsylvania showed that 6% of pediatric EMSs transports are for asthma. 5 Given that respiratory disease in pediatric patients is commonly encountered by EMSs, improving the prehospital care for these patients is a natural target for research and quality improvement efforts. The Pediatric Emergency Care Applied Research Network recently published a list of research goals for the EMSs for Children program that identified respiratory distress and asthma as the second and fourth research priorities, respectively.…”

Emergency department course of patients with asthma receiving initial emergency medical services care—Perspectives From the National Hospital Ambulatory Medical Care Survey

“…The role of EMS in the care of children with acute asthma has been examined in terms of demographics, treatments initiated, and impact on ED stays. [7][8][9] However, similar insights for adults are not known.…”

“…Essential acute asthma interventions performed by EMS may include support of oxygenation and ventilation and administration of inhaled or intravenous medications. The role of EMS in the care of children with acute asthma has been examined in terms of demographics, treatments initiated, and impact on ED stays 7–9 . However, similar insights for adults are not known.…”