Treatment and outcome of adult patients with acute asthma in emergency departments in Australasia, South East Asia and Europe: Are guidelines followed? AANZDEM/EuroDEM study

Craig, Simon; Kuan, Win Sen; Kelly, Anne‐Maree; Meer, Oene van; Motiejūnaitė, Justina; Keijzers, Gerben; Jones, P. G.; Body, Richard; Karamercan, Mehmet Akif; Klim, Sharon; Harjola, Veli Pekka; Verschuren, Franck; Christ, Michael; Golea, Adela; Graham, Colin A.; Capsec, Jean; Barletta, C; Garcı́a-Castrillo, Luis; Laribi, Sai͏̈d

doi:10.1111/1742-6723.13242

Cited by 4 publications

(5 citation statements)

References 21 publications

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“…Substandard care also occurred in the inpatient setting, with 37% inpatients not prescribed an inhaled preventer within the first 24 h of admission, and 76% discharged home without an asthma action plan. Many of our findings are comparable with previous studies, performed over the past three decades, suggesting that minimal improvements have been made to acute asthma care over this period 5,6,8–13 . A recent audit of asthma care at a different Victorian health service identified similar deficiencies, particularly in regards to follow‐up measures such as the provision of asthma action plans 17 .…”

Section: Discussionsupporting

confidence: 85%

“…Clinicians rarely document asthma severity, and peak flow measurements are underutilised 5–8 . Systemic corticosteroids and inhaled beta agonists are widely underprescribed, 6,9–12 while use of inhaled anticholinergics is highly variable 6,11,12 . The use of other adjunctive therapies appears to be uncommon, although available data are limited 13,14 .…”

Section: Introductionmentioning

confidence: 99%

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Quality of acute asthma care: an audit of clinical practice in a Victorian health service

Nash

Southcott

Jayaram

2022

Internal Medicine Journal

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Background Gaps in the treatment of patients with acute asthma have been repeatedly described in Australia. We conducted a retrospective audit of acute asthma care at a Victorian tertiary institution. Aims To describe acute asthma care at a large health network in metropolitan Melbourne, and evaluate the extent to which Emergency Department (ED) care was consistent with National Asthma Council guidelines. Methods A retrospective audit was performed of medical records between July 2017 and June 2019. We included adult patients admitted to campuses within the Western Health network in Melbourne, Victoria, where the length of stay was at least 12 h, and the primary discharge diagnosis was asthma. Results Four hundred and ninety‐three admissions were included in the analysis, representing 392 individual patients. Seventy‐one percent of patients were female and 27% were current smokers. Ninety‐six percent of patients had a prior asthma diagnosis, 63% had a previous hospital presentation and 75% were prescribed an inhaled preventer. In the ED, systemic corticosteroids and inhaled salbutamol were prescribed in 65% and 82% admissions respectively; adjunctive treatments included ipratropium (67% of admissions), magnesium sulfate (30%), adrenaline (11%) and non‐invasive ventilation (9%). Overall, ED care was guideline concordant in 59% of admissions. On the wards, treatments prescribed within 24 h of admission included corticosteroids (90% of admissions), salbutamol (84%), ipratropium (64%) and inhaled preventers (63%). The proportion of patients prescribed these treatments, as well as documented follow up (e.g. asthma action plans), varied significantly depending on the treating specialty. Conclusion The emergency treatment of patients with acute asthma frequently deviated from guidelines and there was significant variation in inpatient treatment. Quality improvement initiatives that incorporate structural changes are required to improve asthma care.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Quality of acute asthma care: an audit of clinical practice in a Victorian health service

Nash

Southcott

Jayaram

2022

Internal Medicine Journal

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“…The 20 studies were conducted in 9 hospitals from 5 teaching medical centers and an additional nonteaching hospital. Nine articles reported results as part of international research [18][19][20][21][22][23][24][25][26]. Research topics included resuscitation [21,[26][27][28][29][30], cardiovascular and respiratory pathologies (syncope [31,32], acute heart failure [22], asthma [25], and dyspnoea [24,33], infectious diseases [19,20], with 1 regarding the paediatric population [19], pre-hospital [18,23], toxicology [34][35][36], trauma [37], and upper gastrointestinal bleeding [38,39].…”

Section: Background and Aimsmentioning

confidence: 99%

“…Our ED has implemented one research protocol [29,30] and has been part of another international research group [24,25].…”

Section: Background and Aimsmentioning

confidence: 99%

Feasibility of a pilot study on point-of-care biomarkers in spontaneous intracerebral hemorrhage in an emergency setting

Mureșan

Golea

Bolboacă

et al. 2021

Medicine and Pharmacy Reports

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Background and aims. Stroke is a worldwide leading cause of death and disability and spontaneous intracerebral hemorrhage (sICH) has significant economic and social impact, regardless of recent efforts towards outcome-bettering acute interventions. The aim of the study was to assess the feasibility of a prospective observational research regarding point-of-care (POC) biomarkers in sICH, conducted in a level one emergency department (ED). Methods. Patients with acute (<8 hours) sICH were enrolled in this study. Patients presenting a Glasgow Coma Scale score <8, secondary causes of intracerebral hemorrhage, seizures, recent ischemic events, known thromboembolic disease, anticoagulant treatment, severe pre-stroke disability, terminal disease, scheduled neurosurgery/ hemostatic treatment were excluded. Feasibility was defined as ED inclusion and follow-up rates, time-to-inclusion, and frequency of missing data. Baseline demographic, imaging and POC biochemical status of the study group were documented, including inflammatory (complete blood count, C-reactive protein), metabolic (glucose, hepatic, and renal function) and cardiovascular markers (cardiac troponin I, D-dimer). Results. The inclusion rate was 2.16 patients/month with a final sample of 35 patients out of 239 potentially eligible patients. The median time from symptom onset to ED presentation was 128 minutes (IQR 96-239), with 21/35 patients having presented within the first 3 hours from ictus. Median times between symptoms’ onset to Computer Tomography (CT) scan and ED presentation to CT scan were 170 minutes (IQR 126-317) and 25 minutes (IQR 17-62), respectively. The median time from patient’s presentation to CBC result was 12 minutes (IQR 6.5-20), with 21/35 study participants having the results available within 15 minutes from ED arrival. The median cohort age was 72-years, with a 19/16 male/female ratio. Hypertension was the most frequent risk factor (77%), along with ischemic heart disease (31%) and diabetes (29%). One-third of the hypertensive patients did not undergo blood pressure lowering treatment. Median values of POC biomarkers on ED admission were within normal range. Conclusions. It was feasible to determine point-of-care biomarkers in spontaneous intracerebral hemorrhage on admission in ED, despite the urgency of the medical condition.

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“…Current recommendations suggest that high dose ICS given within the first hour of the patient’s presentation in the emergency department, reduce the rate of hospital admissions, for patients who are not on systemic corticosteroid therapy [1]. Recent evidence however seems to be conflicting regarding their performance without the use of systemic corticosteroids, when rate of hospital admissions or changes in lung function has been studied [226,227].…”

Section: Pharmacological and Non-pharmacological Managementmentioning

confidence: 99%

Acute Severe Asthma in Adolescent and Adult Patients: Current Perspectives on Assessment and Management

Kostakou

Kaniaris

Filiou

et al. 2019

JCM

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Asthma is a chronic airway inflammatory disease that is associated with variable expiratory flow, variable respiratory symptoms, and exacerbations which sometimes require hospitalization or may be fatal. It is not only patients with severe and poorly controlled asthma that are at risk for an acute severe exacerbation, but this has also been observed in patients with otherwise mild or moderate asthma. This review discusses current aspects on the pathogenesis and pathophysiology of acute severe asthma exacerbations and provides the current perspectives on the management of acute severe asthma attacks in the emergency department and the intensive care unit.

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Treatment and outcome of adult patients with acute asthma in emergency departments in Australasia, South East Asia and Europe: Are guidelines followed? AANZDEM/EuroDEM study

Cited by 4 publications

References 21 publications

Quality of acute asthma care: an audit of clinical practice in a Victorian health service

Quality of acute asthma care: an audit of clinical practice in a Victorian health service

Feasibility of a pilot study on point-of-care biomarkers in spontaneous intracerebral hemorrhage in an emergency setting

Acute Severe Asthma in Adolescent and Adult Patients: Current Perspectives on Assessment and Management

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